This log is also available as text (s02280.txt) and as a (binary) annotation file (s02280.log).
Generated: Monday, 07-Jun-2010 13:20:11 EDT
(All dates below are surrogates.)
t0: [09:49:32 24/01/2013] tf: [18:22:29 31/01/2013] id: a40937 [view]
t0: [08:35:59 24/01/2013] tf: [18:20:59 31/01/2013] id: a40937n [view]
t0: [12:33:59 24/01/2013] tf: [09:31:59 29/01/2013] id: a41645 [view]
t0: [12:32:59 24/01/2013] tf: [10:10:59 29/01/2013] id: a41645n [view]
t0: [18:34:12 24/01/2013] tf: [18:02:21 03/03/2013] id: a41664 [view]
t0: [17:00:59 24/01/2013] tf: [04:27:59 26/01/2013] id: a41664n [view]
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS dd: 5110 ds: 2 ld: PLEURISY W/O EFFUS OR TB
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 486 ds: 1 ld: PNEUMONIA, ORGANISM NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS dd: 4160 ds: 2 ld: PRIM PULM HYPERTENSION
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 78321 ds: 3 ld: LOSS OF WEIGHT dd: 7856 ds: 1 ld: ENLARGEMENT LYMPH NODES dd: 7862 ds: 2 ld: COUGH dd: 7931 ds: 4 ld: ABN FINDINGS-LUNG FIELD dd: V1011 ds: 5 ld: HX-BRONCHOGENIC MALIGNAN
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 1629 ds: 2 ld: MAL NEO BRONCH/LUNG NOS dd: 2123 ds: 1 ld: BENIGN NEO BRONCHUS/LUNG dd: 4940 ds: 5 ld: BRONCHIECTASIS W/O ACTE dd: 51889 ds: 4 ld: OTHER LUNG DISEASE NEC dd: 7931 ds: 6 ld: ABN FINDINGS-LUNG FIELD dd: 7993 ds: 3 ld: DEBILITY NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS dd: 4940 ds: 2 ld: BRONCHIECTASIS W/O ACTE dd: V1011 ds: 3 ld: HX-BRONCHOGENIC MALIGNAN
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 4940 ds: 1 ld: BRONCHIECTASIS W/O ACTE dd: 7993 ds: 2 ld: DEBILITY NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 2113 ds: 2 ld: BENIGN NEOPLASM LG BOWEL dd: V7651 ds: 1 ld: SPEC SCRN MALIG NEO COLO
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS dd: 7931 ds: 2 ld: ABN FINDINGS-LUNG FIELD
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 2765 ds: 3 ld: HYPOVOLEMIA dd: 7850 ds: 2 ld: TACHYCARDIA NOS dd: 78605 ds: 1 ld: SHORTNESS OF BREATH
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS dd: 7993 ds: 2 ld: DEBILITY NOS
dd: 7862 ds: 1 ld: COUGH dd: V1011 ds: 2 ld: HX-BRONCHOGENIC MALIGNAN
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 01100 ds: 3 ld: TB LUNG INFILTR-UNSPEC dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS dd: 1629 ds: 4 ld: MAL NEO BRONCH/LUNG NOS dd: 2312 ds: 2 ld: CA IN SITU BRONCHUS/LUNG dd: 486 ds: 1 ld: PNEUMONIA, ORGANISM NOS dd: 7862 ds: 5 ld: COUGH
dd: 486 ds: 2 ld: PNEUMONIA, ORGANISM NOS dd: 4940 ds: 1 ld: BRONCHIECTASIS W/O ACTE dd: 4941 ds: 3 ld: BRONCHIECTASIS W ACUTE E
dd: 486 ds: 2 ld: PNEUMONIA, ORGANISM NOS dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E
dd: 4841 ds: 1 ld: PNEUM W CYTOMEG INCL DIS dd: 486 ds: 2 ld: PNEUMONIA, ORGANISM NOS dd: 4941 ds: 3 ld: BRONCHIECTASIS W ACUTE E
dd: 486 ds: 2 ld: PNEUMONIA, ORGANISM NOS dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E
dd: 1629 ds: 3 ld: MAL NEO BRONCH/LUNG NOS dd: 486 ds: 2 ld: PNEUMONIA, ORGANISM NOS dd: 486 ds: 4 ld: PNEUMONIA, ORGANISM NOS dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E dd: 4941 ds: 2 ld: BRONCHIECTASIS W ACUTE E dd: 7863 ds: 1 ld: HEMOPTYSIS
dd: 486 ds: 2 ld: PNEUMONIA, ORGANISM NOS dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E
dd: 486 ds: 2 ld: PNEUMONIA, ORGANISM NOS dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E
dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E
dd: 5183 ds: 1 ld: PULMONARY EOSINOPHILIA
dd: 486 ds: 3 ld: PNEUMONIA, ORGANISM NOS dd: 4940 ds: 2 ld: BRONCHIECTASIS W/O ACTE dd: 7862 ds: 1 ld: COUGH dd: 7863 ds: 4 ld: HEMOPTYSIS
dd: 486 ds: 2 ld: PNEUMONIA, ORGANISM NOS dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS dd: 6000 ds: 2 ld: HYPERTROPHY OF PROSTATE dd: 7862 ds: 3 ld: COUGH
dd: 460 ds: 1 ld: ACUTE NASOPHARYNGITIS dd: 4940 ds: 2 ld: BRONCHIECTASIS W/O ACTE
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS dd: 7863 ds: 2 ld: HEMOPTYSIS
dd: 1629 ds: 3 ld: MAL NEO BRONCH/LUNG NOS dd: 4940 ds: 1 ld: BRONCHIECTASIS W/O ACTE dd: 7863 ds: 2 ld: HEMOPTYSIS
dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E
dd: 1629 ds: 1 ld: MAL NEO BRONCH/LUNG NOS
dd: 486 ds: 2 ld: PNEUMONIA, ORGANISM NOS dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E
dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E
dd: 4940 ds: 2 ld: BRONCHIECTASIS W/O ACTE dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E
dd: 1629 ds: 4 ld: MAL NEO BRONCH/LUNG NOS dd: 2761 ds: 9 ld: HYPOSMOLALITY dd: 2765 ds: 8 ld: HYPOVOLEMIA dd: 2859 ds: 2 ld: ANEMIA NOS dd: 4280 ds: 7 ld: CONGESTIVE HEART FAILURE dd: 4538 ds: 6 ld: VENOUS THROMBOSIS NEC dd: 486 ds: 5 ld: PNEUMONIA, ORGANISM NOS dd: 5119 ds: 1 ld: PLEURAL EFFUSION NOS dd: 5121 ds: 4 ld: IATROGENIC PNEUMOTHORAX dd: 51881 ds: 2 ld: RESPIRATORY FAILURE dd: 51889 ds: 1 ld: OTHER LUNG DISEASE NEC dd: 5849 ds: 3 ld: ACUTE RENAL FAILURE NOS
dd: 2767 ds: 2 ld: HYPERPOTASSEMIA dd: 4019 ds: 1 ld: HYPERTENSION NOS dd: 5849 ds: 3 ld: ACUTE RENAL FAILURE NOS dd: V1011 ds: 4 ld: HX-BRONCHOGENIC MALIGNAN
dd: 2767 ds: 1 ld: HYPERPOTASSEMIA dd: 2859 ds: 8 ld: ANEMIA NOS dd: 4019 ds: 6 ld: HYPERTENSION NOS dd: 4940 ds: 7 ld: BRONCHIECTASIS W/O ACTE dd: 5119 ds: 3 ld: PLEURAL EFFUSION NOS dd: 58389 ds: 9 ld: NEPHRITIS NEC dd: 5849 ds: 2 ld: ACUTE RENAL FAILURE NOS dd: E9426 ds: 4 ld: ADV EFF ANTIHYPERTEN AGT dd: V1011 ds: 5 ld: HX-BRONCHOGENIC MALIGNAN
dd: 5119 ds: 1 ld: PLEURAL EFFUSION NOS
dd: 1629 ds: 3 ld: MAL NEO BRONCH/LUNG NOS dd: 4940 ds: 1 ld: BRONCHIECTASIS W/O ACTE dd: 5119 ds: 2 ld: PLEURAL EFFUSION NOS
dd: 5819 ds: 1 ld: NEPHROTIC SYNDROME NOS dd: 585 ds: 4 ld: CHRONIC RENAL FAILURE dd: 5997 ds: 3 ld: HEMATURIA dd: 7823 ds: 2 ld: EDEMA
dd: 2767 ds: 4 ld: HYPERPOTASSEMIA dd: 2800 ds: 3 ld: CHR BLOOD LOSS ANEMIA dd: 4168 ds: 5 ld: CHR PULMON HEART DIS NEC dd: 4940 ds: 6 ld: BRONCHIECTASIS W/O ACTE dd: 5119 ds: 2 ld: PLEURAL EFFUSION NOS dd: 5849 ds: 1 ld: ACUTE RENAL FAILURE NOS dd: 5997 ds: 7 ld: HEMATURIA dd: V1011 ds: 8 ld: HX-BRONCHOGENIC MALIGNAN dd: V1251 ds: 9 ld: PERS HX VENOUS THROM/EMB
dd: 4538 ds: 1 ld: VENOUS THROMBOSIS NEC dd: 72981 ds: 2 ld: SWELLING OF LIMB
dd: 4538 ds: 1 ld: VENOUS THROMBOSIS NEC dd: 5119 ds: 3 ld: PLEURAL EFFUSION NOS dd: 53081 ds: 4 ld: ESOPHAGEAL REFLUX dd: 5819 ds: 2 ld: NEPHROTIC SYNDROME NOS dd: V1011 ds: 5 ld: HX-BRONCHOGENIC MALIGNAN dd: V1201 ds: 6 ld: PERS HIST TUBERCULOSIS dd: V1584 ds: 7 ld: PERS HX EXPO TO ASBESTOS
dd: 486 ds: 3 ld: PNEUMONIA, ORGANISM NOS dd: 78605 ds: 2 ld: SHORTNESS OF BREATH dd: 7863 ds: 1 ld: HEMOPTYSIS
dd: 4941 ds: 2 ld: BRONCHIECTASIS W ACUTE E dd: 5119 ds: 3 ld: PLEURAL EFFUSION NOS dd: 5191 ds: 4 ld: TRACHEA/BRONCHUS DIS NEC dd: 7863 ds: 1 ld: HEMOPTYSIS
dd: 2765 ds: 2 ld: HYPOVOLEMIA dd: 78909 ds: 1 ld: ABDOMIN PAIN OTHR SPEC S
dd: 2767 ds: 1 ld: HYPERPOTASSEMIA dd: 2859 ds: 4 ld: ANEMIA NOS dd: 42732 ds: 2 ld: ATRIAL FLUTTER dd: 585 ds: 3 ld: CHRONIC RENAL FAILURE dd: 5997 ds: 5 ld: HEMATURIA dd: V1011 ds: 6 ld: HX-BRONCHOGENIC MALIGNAN
dd: 4019 ds: 2 ld: HYPERTENSION NOS dd: 5820 ds: 3 ld: CHR PROLIFERAT NEPHRITIS dd: 5839 ds: 4 ld: NEPHRITIS NOS dd: 5939 ds: 1 ld: RENAL & URETERAL DIS NOS
dd: 4940 ds: 1 ld: BRONCHIECTASIS W/O ACTE dd: 5111 ds: 4 ld: BACT PLEUR/EFFUS NOT TB dd: 5119 ds: 2 ld: PLEURAL EFFUSION NOS dd: 5180 ds: 5 ld: PULMONARY COLLAPSE dd: 7863 ds: 3 ld: HEMOPTYSIS
dd: 5820 ds: 2 ld: CHR PROLIFERAT NEPHRITIS dd: 5939 ds: 1 ld: RENAL & URETERAL DIS NOS
dd: 2767 ds: 4 ld: HYPERPOTASSEMIA dd: 2859 ds: 2 ld: ANEMIA NOS dd: 4019 ds: 8 ld: HYPERTENSION NOS dd: 4239 ds: 5 ld: PERICARDIAL DISEASE NOS dd: 42731 ds: 1 ld: ATRIAL FIBRILLATION dd: 5119 ds: 3 ld: PLEURAL EFFUSION NOS dd: 5832 ds: 7 ld: MEMBRANOPROLIF NEPHR NOS dd: 5849 ds: 2 ld: ACUTE RENAL FAILURE NOS dd: V1011 ds: 6 ld: HX-BRONCHOGENIC MALIGNAN
dd: 4280 ds: 2 ld: CONGESTIVE HEART FAILURE dd: 4941 ds: 1 ld: BRONCHIECTASIS W ACUTE E dd: 78609 ds: 3 ld: RESPIRATORY ABNORM NEC
dd: 1173 ds: 2 ld: ASPERGILLOSIS dd: 42099 ds: 1 ld: ACUTE PERICARDITIS NEC dd: 4232 ds: 5 ld: CONSTRICTIV PERICARDITIS dd: 4275 ds: 3 ld: CARDIAC ARREST dd: 4280 ds: 1 ld: CONGESTIVE HEART FAILURE dd: 4280 ds: 4 ld: CONGESTIVE HEART FAILURE dd: 5109 ds: 6 ld: EMPYEMA W/O FISTULA dd: 51884 ds: 7 ld: ACUTE & CHR RESP FAILURE dd: 5845 ds: 8 ld: LOWER NEPHRON NEPHROSIS dd: 99811 ds: 9 ld: HEMORR COMPLIC PROCEDURE
tf: [11:00:00 15/12/2015] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Digoxin v1: 0.125 u1: mg
tf: [15:00:00 11/12/2015] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 75 u1: mg
tf: [19:00:00 03/12/2015] pt: Unit Dose rt: SC fr: Q12H fs: 23, 11 dn: 2 m1: Heparin v1: 5000 u1: UNIT tf: [13:00:00 23/12/2015] pt: Unit Dose rt: PO fr: Q24H fs: 23 dn: 1 m1: Pantoprazole v1: 40 u1: mg
tf: [16:00:00 09/12/2015] pt: Unit Dose rt: PO fr: HS:PRN m1: Lorazepam v1: 0.5 u1: mg
tf: [02:00:00 23/12/2015] pt: Unit Dose rt: IH fr: Q6H:PRN m1: Albuterol Neb Soln v1: 1 u1: NEB tf: [02:00:00 23/12/2015] pt: Unit Dose rt: IH fr: Q6H:PRN m1: Ipratropium Bromide Neb v1: 1 u1: NEB
tf: [09:00:00 02/12/2015] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Furosemide v1: 20 u1: mg
id: D5W el: 1 cu: CCU cg: RN io: D5W 250.0ml IV Infusions vo: 250 du: ml rt: Intravenous Push id: D5/.45NS el: 1 cu: CCU cg: RN io: D5/.45NS 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push
tf: [21:40:00 02/12/2015] dt: 1660 cu: CCU de: FA2
t0: [18:00:00 01/12/2015] id: BSA el: 1033 cu: CCU cg: 8 t0: [18:00:00 01/12/2015] id: Admit Wt el: 1032 cu: CCU cg: 8 t0: [18:00:00 01/12/2015] id: Allergy 1 el: 1020 cu: CCU cg: 8 t0: [18:00:00 01/12/2015] id: Diagnosis/op el: 1023 cu: CCU cg: 8 v1: CONGESTIVE HEART FAILURE;TELEMETRY t0: [18:00:00 01/12/2015] id: Service el: 1026 cu: CCU cg: 8 v1: CME t0: [18:00:00 01/12/2015] id: Admit Ht el: 1034 cu: CCU cg: 8 t0: [18:00:00 01/12/2015] id: Readmission el: 1014 cu: CCU cg: 8 t0: [18:00:00 01/12/2015] id: Marital Status el: 1006 cu: CCU cg: 8 v1: M t0: [18:00:00 01/12/2015] id: Religion el: 1000 cu: CCU cg: 8 v1: NSP t0: [18:00:00 01/12/2015] id: Allergy 2 el: 1021 cu: CCU cg: 8 t0: [18:00:00 01/12/2015] id: Ext el: 1010 cu: CCU cg: 8 t0: [18:00:00 01/12/2015] id: PIN el: 1012 cu: CCU cg: 8 t0: [18:00:00 01/12/2015] id: Allergy 3 el: 1022 cu: CCU cg: 8
io: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ra: 10 ru: ml/hr
tf: [20:00:00 01/12/2015] pt: Unit Dose rt: PO fr: ONCE fs: 18 dn: 1 m1: Sodium Polystyrene Sulfonate v1: 60 u1: gm
id: D5W el: 1 cu: CCU cg: -1 io: D5W 100.0ml IV Infusions vo: 100 du: ml rt: Intravenous Push id: .9% Normal Saline el: 1 cu: CCU cg: RN io: .9% Normal Saline 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push id: Cath Lab Intake el: 1 cu: CCU cg: RN io: Cath Lab Intake Cath Lab Intake du: ml rt: Intravenous Push id: Po Intake el: 1 cu: CCU cg: -1 io: Po Intake PO/Gastric du: ml rt: Oral
t0: [18:00:00 01/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [18:00:00 01/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 01/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 01/12/2015] id: Readmit <48 hrs el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [18:00:00 01/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 01/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [18:00:00 01/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [18:00:00 01/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 67 u1: BPM st: NotStopd t0: [18:00:00 01/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 01/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:00:00 01/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [18:00:00 01/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [18:00:00 01/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [18:00:00 01/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 01/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [18:00:00 01/12/2015] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: No/Not Sedated st: NotStopd t0: [18:00:00 01/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [18:00:00 01/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [18:00:00 01/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 01/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [18:00:00 01/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [18:00:00 01/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry st: NotStopd t0: [18:00:00 01/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [18:00:00 01/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 139 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [18:00:00 01/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 97.6667 u1: mmHg st: NotStopd t0: [18:00:00 01/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [18:00:00 01/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 01/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [18:00:00 01/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [18:00:00 01/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [18:00:00 01/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [18:00:00 01/12/2015] tf: [12:00:00 02/12/2015] dt: 1080 id: Pericard Drain Stat el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [18:00:00 01/12/2015] tf: [12:00:00 02/12/2015] dt: 1080 id: Pericardial Drainage el: 0 cu: CCU cg: RN v1: Gravity st: NotStopd t0: [18:00:00 01/12/2015] id: Pericardial Drainage el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 01/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [18:00:00 01/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [18:00:00 01/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [18:00:00 01/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 22 u1: BPM st: NotStopd t0: [18:00:00 01/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [18:00:00 01/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd
t0: [18:00:00 01/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [18:00:00 01/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Venous Access v2: Right Femoral st: NotStopd t0: [18:00:00 01/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [18:00:00 01/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 2 st: NotStopd t0: [18:00:00 01/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [18:00:00 01/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [18:00:00 01/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 01/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 01/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [18:00:00 01/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [18:00:00 01/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [18:00:00 01/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [18:00:00 01/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Rarely Moist st: NotStopd t0: [18:00:00 01/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [18:00:00 01/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 15 u1: number st: NotStopd t0: [18:00:00 01/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: No Impairment st: NotStopd
t0: [18:00:00 01/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 0 vu: ml nb: 1
t0: [18:30:00 01/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [18:30:00 01/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [18:30:00 01/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 01/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:30:00 01/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:30:00 01/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [18:30:00 01/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 135 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [18:30:00 01/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [18:30:00 01/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:30:00 01/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 22 u1: BPM st: NotStopd t0: [18:30:00 01/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [18:30:00 01/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:45:00 01/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [18:45:00 01/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:45:00 01/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:45:00 01/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:45:00 01/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:45:00 01/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [18:45:00 01/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 135 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [18:45:00 01/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 102.333 u1: mmHg st: NotStopd t0: [18:45:00 01/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:45:00 01/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:45:00 01/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 01/12/2015] tf: [21:40:00 02/12/2015] dt: 1600 id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 300 vu: ml t0: [19:00:00 01/12/2015] tf: [21:00:00 01/12/2015] dt: 120 id: Drain Out #1 Pericardial el: 1 cu: CCU cg: RN vo: 4 vu: ml
tf: [20:00:00 02/12/2015] pt: Unit Dose rt: IV fr: ONCE fs: 21 dn: 1 m1: Furosemide v1: 40 u1: mg
t0: [19:00:00 01/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [19:00:00 01/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [19:00:00 01/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 01/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 01/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 01/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [19:00:00 01/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 01/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 131 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [19:00:00 01/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 100.333 u1: mmHg st: NotStopd t0: [19:00:00 01/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [19:00:00 01/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 17 u1: BPM st: NotStopd t0: [19:00:00 01/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [19:00:00 01/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 01/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [20:00:00 01/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [20:00:00 01/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 01/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 73 u1: BPM st: NotStopd t0: [20:00:00 01/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 01/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 138 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [20:00:00 01/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 101.333 u1: mmHg st: NotStopd t0: [20:00:00 01/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:00:00 01/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 15 u1: BPM st: NotStopd t0: [20:00:00 01/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [20:00:00 01/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 01/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [21:00:00 01/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [21:00:00 01/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 01/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 01/12/2015] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: No/Not Sedated st: NotStopd t0: [21:00:00 01/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [21:00:00 01/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Clear Liquid st: NotStopd t0: [21:00:00 01/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [21:00:00 01/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [21:00:00 01/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [21:00:00 01/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Family Visited st: NotStopd t0: [21:00:00 01/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [21:00:00 01/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [21:00:00 01/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [21:00:00 01/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 01/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Venous Access v2: Right Femoral st: NotStopd t0: [21:00:00 01/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:00:00 01/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 2 st: NotStopd t0: [21:00:00 01/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [21:00:00 01/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [21:00:00 01/12/2015] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 01/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 01/12/2015] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Good st: NotStopd t0: [21:00:00 01/12/2015] id: LLE Temp/Color el: 0 cu: CCU cg: RN v1: Cool v2: Pale st: NotStopd t0: [21:00:00 01/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 01/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 01/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [21:00:00 01/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [21:00:00 01/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 01/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 132 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [21:00:00 01/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 100.667 u1: mmHg st: NotStopd t0: [21:00:00 01/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [21:00:00 01/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 01/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [21:00:00 01/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [21:00:00 01/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [21:00:00 01/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [21:00:00 01/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [21:00:00 01/12/2015] id: Pericard Drain Stat el: 0 cu: CCU cg: RN v1: Gravity st: NotStopd t0: [21:00:00 01/12/2015] id: Pericardial Drainage el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 01/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [21:00:00 01/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [21:00:00 01/12/2015] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 01/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [21:00:00 01/12/2015] id: RLE Temp/Color el: 0 cu: CCU cg: RN v1: Cool v2: Pale st: NotStopd t0: [21:00:00 01/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [21:00:00 01/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [21:00:00 01/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [21:00:00 01/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 23 u1: BPM st: NotStopd t0: [21:00:00 01/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 01/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 01/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [21:00:00 01/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [21:00:00 01/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [21:00:00 01/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [21:00:00 01/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [21:00:00 01/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.2 u1: Deg. F st: NotStopd t0: [21:00:00 01/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd t0: [21:00:00 01/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [21:00:00 01/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Condom Catheter st: NotStopd t0: [21:00:00 01/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [21:00:00 01/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 01/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Anxious st: NotStopd t0: [21:00:00 01/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [21:00:00 01/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [21:00:00 01/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [21:00:00 01/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [21:00:00 01/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Rarely Moist st: NotStopd t0: [21:00:00 01/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Adequate st: NotStopd t0: [21:00:00 01/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 14 u1: number st: NotStopd t0: [21:00:00 01/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd
t0: [21:00:00 01/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 50 vu: ml t0: [21:00:00 01/12/2015] tf: [16:00:00 02/12/2015] dt: 1140 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 30 vu: ml t0: [21:00:00 01/12/2015] id: Drain Out #1 Pericardial el: 1 cu: CCU cg: RN vo: 0 vu: ml
t0: [23:00:00 01/12/2015] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: RN cv: 350 ap: none t0: [23:00:00 01/12/2015] dt: 24 id: Drain #1 Total Out el: 1 cu: CCU cg: RN cv: 4 ap: none
t0: [21:00:00 01/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 16 u1: mmHg st: NotStopd
t0: [21:00:00 01/12/2015] tf: [21:40:00 02/12/2015] dt: 1480 id: Urine Out Condom Cath el: 1 cu: CCU cg: RN vo: 200 vu: ml
t0: [23:00:00 01/12/2015] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN cv: 0 ap: none t0: [23:00:00 01/12/2015] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN cv: 200 ap: none t0: [23:00:00 01/12/2015] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN cv: 204 ap: none
t0: [20:00:00 01/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: Occasional st: NotStopd t0: [20:00:00 01/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: PVC's st: NotStopd t0: [21:00:00 01/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: Occasional st: NotStopd t0: [21:00:00 01/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: PVC's st: NotStopd
t0: [22:00:00 01/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [22:00:00 01/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [22:00:00 01/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 01/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: Rare st: NotStopd t0: [22:00:00 01/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: PVC's st: NotStopd t0: [22:00:00 01/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [22:00:00 01/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 01/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 132 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [22:00:00 01/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 94.6667 u1: mmHg st: NotStopd t0: [22:00:00 01/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:00:00 01/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 23 u1: BPM st: NotStopd t0: [22:00:00 01/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [22:00:00 01/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 01/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml
t0: [23:00:00 01/12/2015] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN cv: 0 ap: none t0: [23:00:00 01/12/2015] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN cv: 40 ap: none t0: [23:00:00 01/12/2015] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN cv: 390 ap: none t0: [23:00:00 01/12/2015] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN cv: 186 ap: none t0: [23:00:00 01/12/2015] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN cv: 186 ap: none
t0: [23:00:00 01/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [23:00:00 01/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [23:00:00 01/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 01/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 01/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 01/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [23:00:00 01/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 01/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 123 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [23:00:00 01/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 93.6667 u1: mmHg st: NotStopd t0: [23:00:00 01/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [23:00:00 01/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd t0: [23:00:00 01/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 91 u1: % st: NotStopd t0: [23:00:00 01/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:09:00 01/12/2015] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 6.2 rs: Final st: NotStopd t0: [23:09:00 01/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 6.2 rs: Final st: NotStopd
tf: [23:00:00 02/12/2015] pt: Unit Dose rt: PO fr: ONCE fs: 0 dn: 1 m1: Sodium Polystyrene Sulfonate v1: 60 u1: gm
t0: [00:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [00:00:00 02/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [00:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: Rare st: NotStopd t0: [00:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: PVC's st: NotStopd t0: [00:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 62 u1: BPM st: NotStopd t0: [00:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 117 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [00:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [00:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 19 u1: BPM st: NotStopd t0: [00:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 02/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 180 vu: ml t0: [00:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml
t0: [23:00:00 02/12/2015] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN cv: 0 ap: none t0: [23:00:00 02/12/2015] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN cv: 140 ap: none t0: [23:00:00 02/12/2015] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN cv: 1460 ap: none t0: [23:00:00 02/12/2015] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: RN cv: 1320 ap: none t0: [23:00:00 02/12/2015] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN cv: 624.5 ap: carryForward t0: [23:00:00 02/12/2015] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN cv: 810.5 ap: carryForward
t0: [01:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [01:00:00 02/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [01:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [01:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 117 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [01:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 81.6667 u1: mmHg st: NotStopd t0: [01:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [01:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [02:00:00 02/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [02:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [02:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 119 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [02:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [02:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [02:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 15 u1: BPM st: NotStopd t0: [02:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 01/12/2015] id: Procedures el: 0 cu: CCU cg: RN v1: EKG st: NotStopd t0: [03:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [03:00:00 02/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [03:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: Occasional st: NotStopd t0: [03:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: PVC's st: NotStopd t0: [03:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [03:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 120 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [03:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 91.3333 u1: mmHg st: NotStopd t0: [03:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [03:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [03:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 30 vu: ml
t0: [04:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [04:00:00 02/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [04:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: Occasional st: NotStopd t0: [04:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: PVC's st: NotStopd t0: [04:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [04:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 116 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [04:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 82.6667 u1: mmHg st: NotStopd t0: [04:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 24 u1: BPM st: NotStopd t0: [04:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [04:00:00 02/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [04:00:00 02/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [04:00:00 02/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [04:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [05:00:00 02/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [05:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 60 u1: BPM st: NotStopd t0: [05:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 119 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [05:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 84.3333 u1: mmHg st: NotStopd t0: [05:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 17 u1: BPM st: NotStopd t0: [05:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [05:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 02/12/2015] tf: [21:40:00 02/12/2015] dt: 1060 id: Drain Out #1 Pericardial el: 1 cu: CCU cg: RN vo: 0 vu: ml t0: [04:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 02/12/2015] id: Drain Out #1 Pericardial el: 1 cu: CCU cg: RN vo: 0.5 vu: ml t0: [05:00:00 02/12/2015] id: Stool Out Stool el: 1 cu: CCU cg: RN vu: ml es: Large
t0: [23:00:00 02/12/2015] dt: 24 id: Drain #1 Total Out el: 1 cu: CCU cg: RN cv: 0.5 ap: none
t0: [04:00:00 02/12/2015] id: Urine Out Condom Cath el: 1 cu: CCU cg: RN vo: 250 vu: ml t0: [05:00:00 02/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 120 vu: ml t0: [05:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 02/12/2015] id: Urine Out Condom Cath el: 1 cu: CCU cg: RN vu: ml
t0: [04:58:00 02/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 17 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 17 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 33.2 u1: % rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 10.1 u1: gm/dl rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 633 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 3.62 u1: /mic l rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 17 rs: Final st: NotStopd
t0: [04:58:00 02/12/2015] id: BUN el: 0 cu: CCU cg: 140 v1: 94 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 96 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 1.9 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 139 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 5.6 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 132 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 94 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 27 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 96 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 1.9 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 139 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 5.6 rs: Final st: NotStopd t0: [04:58:00 02/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 132 rs: Final st: NotStopd
t0: [06:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [06:00:00 02/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [06:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 74 u1: BPM st: NotStopd t0: [06:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 129 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [06:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 93.6667 u1: mmHg st: NotStopd t0: [06:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [06:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 20 u1: BPM st: NotStopd t0: [06:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [06:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 02/12/2015] id: Stool Out Stool el: 1 cu: CCU cg: RN vu: ml es: Large
t0: [21:00:00 01/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [21:00:00 01/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 02/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 02/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Clear Liquid st: NotStopd t0: [00:00:00 02/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [00:00:00 02/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [00:00:00 02/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 02/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [00:00:00 02/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 02/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [00:00:00 02/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [00:00:00 02/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Venous Access v2: Right Femoral st: NotStopd t0: [00:00:00 02/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 02/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 2 st: NotStopd t0: [00:00:00 02/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 02/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [00:00:00 02/12/2015] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 02/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 02/12/2015] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 02/12/2015] id: LLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [00:00:00 02/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 02/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 02/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Dozing Intermit st: NotStopd t0: [00:00:00 02/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [00:00:00 02/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 02/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [00:00:00 02/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 02/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [00:00:00 02/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [00:00:00 02/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [00:00:00 02/12/2015] id: Pericard Drain Stat el: 0 cu: CCU cg: RN v1: Gravity st: NotStopd t0: [00:00:00 02/12/2015] id: Pericardial Drainage el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 02/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [00:00:00 02/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [00:00:00 02/12/2015] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 02/12/2015] id: RLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [00:00:00 02/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [00:00:00 02/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [00:00:00 02/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [00:00:00 02/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 02/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 02/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [00:00:00 02/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 02/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 02/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 02/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Condom Catheter st: NotStopd t0: [00:00:00 02/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [00:00:00 02/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [01:00:00 02/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [01:00:00 02/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 02/12/2015] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: No/Not Sedated st: NotStopd t0: [01:00:00 02/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 02/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 02/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 02/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Clear Liquid st: NotStopd t0: [04:00:00 02/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [04:00:00 02/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [04:00:00 02/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 02/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [04:00:00 02/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 02/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [04:00:00 02/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [04:00:00 02/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [04:00:00 02/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 02/12/2015] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 02/12/2015] id: LLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [04:00:00 02/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 02/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 02/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [04:00:00 02/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [04:00:00 02/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 02/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [04:00:00 02/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 02/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [04:00:00 02/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [04:00:00 02/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [04:00:00 02/12/2015] id: Pericard Drain Stat el: 0 cu: CCU cg: RN v1: Gravity st: NotStopd t0: [04:00:00 02/12/2015] id: Pericardial Drainage el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 02/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [04:00:00 02/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [04:00:00 02/12/2015] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 02/12/2015] id: RLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [04:00:00 02/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [04:00:00 02/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [04:00:00 02/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [04:00:00 02/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 02/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 02/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 02/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 02/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Condom Catheter st: NotStopd t0: [04:00:00 02/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [04:00:00 02/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [05:00:00 02/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [05:00:00 02/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 02/12/2015] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: No/Not Sedated st: NotStopd t0: [05:00:00 02/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Venous Access v2: Right Femoral st: NotStopd t0: [05:00:00 02/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 02/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 2 st: NotStopd t0: [05:00:00 02/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [05:00:00 02/12/2015] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [05:00:00 02/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 02/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [05:00:00 02/12/2015] id: Pain Type el: 0 cu: CCU cg: RN v1: None st: NotStopd
t0: [08:00:00 02/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [08:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [08:00:00 02/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [08:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 02/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 02/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 02/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Clear Liquid st: NotStopd t0: [08:00:00 02/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 02/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [08:00:00 02/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [08:00:00 02/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 02/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 02/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [08:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [08:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 02/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Venous Access v2: Right Femoral st: NotStopd t0: [08:00:00 02/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 2 st: NotStopd t0: [08:00:00 02/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [08:00:00 02/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [08:00:00 02/12/2015] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 02/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 02/12/2015] id: LLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [08:00:00 02/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [08:00:00 02/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [08:00:00 02/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [08:00:00 02/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 113 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [08:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [08:00:00 02/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [08:00:00 02/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 02/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:00:00 02/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [08:00:00 02/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 02/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [08:00:00 02/12/2015] id: Pericard Drain Stat el: 0 cu: CCU cg: RN v1: Gravity st: NotStopd t0: [08:00:00 02/12/2015] id: Pericardial Drainage el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 02/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [08:00:00 02/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 02/12/2015] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:00:00 02/12/2015] id: RLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [08:00:00 02/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 02/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [08:00:00 02/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [08:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 23 u1: BPM st: NotStopd t0: [08:00:00 02/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 02/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 02/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [08:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [08:00:00 02/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 02/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [08:00:00 02/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [08:00:00 02/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [08:00:00 02/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 02/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 02/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Condom Catheter st: NotStopd t0: [08:00:00 02/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 02/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [08:00:00 02/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 02/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 02/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 02/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 02/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 02/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 14 u1: number st: NotStopd t0: [08:00:00 02/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: No Impairment st: NotStopd
t0: [08:00:00 02/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 180 vu: ml t0: [08:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml
t0: [10:00:00 02/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: -1 st: D/C'd t0: [10:00:00 02/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: -1 st: D/C'd t0: [10:00:00 02/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: -1 st: D/C'd t0: [10:00:00 02/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: -1 st: D/C'd t0: [10:00:00 02/12/2015] id: INV#1 WaveformAppear el: 0 cu: CCU cg: -1 st: D/C'd
t0: [09:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [09:00:00 02/12/2015] id: CVP el: 0 cu: CCU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [09:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 63 u1: BPM st: NotStopd t0: [09:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 02/12/2015] id: IV #1 Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 3 st: NotStopd t0: [09:00:00 02/12/2015] id: IV #1 Site/Size el: 0 cu: CCU cg: RN v1: LL Post Forearm v2: 20 gauge st: NotStopd t0: [09:00:00 02/12/2015] id: IV Site Appear #1 el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [09:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 113 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [09:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 80.3333 u1: mmHg st: NotStopd t0: [09:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 28 u1: BPM st: NotStopd t0: [09:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 02/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [10:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [10:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 02/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 02/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Clear Liquid st: NotStopd t0: [10:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 02/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [10:00:00 02/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [10:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 66 u1: BPM st: NotStopd t0: [10:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 02/12/2015] id: INV Line#1 D/C Date el: 0 cu: CCU cg: RN v1: 12 v2: 3 st: NotStopd t0: [10:00:00 02/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [10:00:00 02/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [10:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 113 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [10:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [10:00:00 02/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [10:00:00 02/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [10:00:00 02/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [10:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:00:00 02/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [10:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 17 u1: BPM st: NotStopd t0: [10:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 02/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Condom Catheter st: NotStopd t0: [10:00:00 02/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [10:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [10:00:00 02/12/2015] id: Stool Out Stool el: 1 cu: CCU cg: RN vu: ml es: Small t0: [10:00:00 02/12/2015] id: Urine Out Condom Cath el: 1 cu: CCU cg: RN vo: 150 vu: ml
t0: [23:00:00 02/12/2015] dt: 24 id: Stool Out Total el: 1 cu: CCU cg: RN cv: 0 ap: carryForward
t0: [11:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [11:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 67 u1: BPM st: NotStopd t0: [11:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 126 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [11:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 93.3333 u1: mmHg st: NotStopd t0: [11:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [11:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 27 u1: BPM st: NotStopd t0: [11:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [11:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 02/12/2015] tf: [21:40:00 02/12/2015] dt: 640 id: Chest Tubes Left Pleural 1 el: 1 cu: CCU cg: RN vo: 300 vu: ml
t0: [23:00:00 02/12/2015] dt: 24 id: Chest Tube Out Total el: 1 cu: CCU cg: RN cv: 300 ap: none
t0: [12:00:00 02/12/2015] id: Pericard Drain Stat el: 0 cu: CCU cg: -1 st: D/C'd t0: [12:00:00 02/12/2015] id: Pericardial Drainage el: 0 cu: CCU cg: -1 st: D/C'd
t0: [08:00:00 02/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 02/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [12:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [12:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 02/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 02/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 02/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: NAS/Low Cholest st: NotStopd t0: [12:00:00 02/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 02/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [12:00:00 02/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [12:00:00 02/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [12:00:00 02/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 02/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Family Called st: NotStopd t0: [12:00:00 02/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [12:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [12:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 02/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [12:00:00 02/12/2015] id: IV #1 Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 3 st: NotStopd t0: [12:00:00 02/12/2015] id: IV #1 Site/Size el: 0 cu: CCU cg: RN v1: LL Post Forearm v2: 20 gauge st: NotStopd t0: [12:00:00 02/12/2015] id: LLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [12:00:00 02/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 02/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [12:00:00 02/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [12:00:00 02/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [12:00:00 02/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 122 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [12:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [12:00:00 02/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [12:00:00 02/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 02/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [12:00:00 02/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [12:00:00 02/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 02/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [12:00:00 02/12/2015] id: RLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [12:00:00 02/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 02/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [12:00:00 02/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [12:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [12:00:00 02/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 02/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 02/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [12:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [12:00:00 02/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 02/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 02/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.8333 u1: Deg. C st: NotStopd t0: [12:00:00 02/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 96.5 u1: Deg. F st: NotStopd t0: [12:00:00 02/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Condom Catheter st: NotStopd t0: [12:00:00 02/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [12:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 02/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd
t0: [10:00:00 02/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 180 vu: ml t0: [12:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml
t0: [12:00:00 02/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 180 vu: ml
t0: [04:58:00 02/12/2015] id: Serum Osmolality Chemistry el: 0 cu: CCU cg: 140 v1: 312 rs: Final st: NotStopd
t0: [16:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: CoWker v1: CCU st: NotStopd t0: [16:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: CoWker v1: Full Code st: NotStopd t0: [16:00:00 02/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: CoWker v1: Calm/Cooperative st: NotStopd t0: [16:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: CoWker v1: None st: NotStopd t0: [16:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: CoWker v1: None st: NotStopd t0: [16:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: CoWker v1: 70 u1: BPM st: NotStopd t0: [16:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: CoWker v1: Normal Sinus st: NotStopd t0: [16:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: CoWker v1: 134 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [16:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: CoWker v1: 100.667 u1: mmHg st: NotStopd t0: [16:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: CoWker v1: Universal st: NotStopd t0: [16:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: CoWker v1: 31 u1: BPM st: NotStopd t0: [16:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: CoWker v1: 97 u1: % st: NotStopd t0: [16:00:00 02/12/2015] id: Temp. Site el: 0 cu: CCU cg: CoWker v1: Axillary st: NotStopd t0: [16:00:00 02/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: CoWker v1: 36.1111 u1: Deg. C st: NotStopd t0: [16:00:00 02/12/2015] id: Temperature F el: 0 cu: CCU cg: CoWker v1: 97 u1: Deg. F st: NotStopd t0: [16:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: CoWker v1: 1 u1: kg st: NotStopd
t0: [17:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: -1 ai: 107 vo: 0 st: D/C'd
t0: [16:00:00 02/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [16:00:00 02/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 02/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: NAS/Low Cholest st: NotStopd t0: [16:00:00 02/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 02/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [16:00:00 02/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 02/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [16:00:00 02/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 02/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 02/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [16:00:00 02/12/2015] id: IV #1 Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 3 st: NotStopd t0: [16:00:00 02/12/2015] id: IV #1 Site/Size el: 0 cu: CCU cg: RN v1: LL Post Forearm v2: 20 gauge st: NotStopd t0: [16:00:00 02/12/2015] id: LLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [16:00:00 02/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 02/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [16:00:00 02/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [16:00:00 02/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [16:00:00 02/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 02/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [16:00:00 02/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 02/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 02/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [16:00:00 02/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 02/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 02/12/2015] id: RLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [16:00:00 02/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 02/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [16:00:00 02/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [16:00:00 02/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 02/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 02/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 02/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 02/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Condom Catheter st: NotStopd t0: [16:00:00 02/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 02/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [16:00:00 02/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 02/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 02/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 02/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 02/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 02/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 15 u1: number st: NotStopd t0: [16:00:00 02/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: No Impairment st: NotStopd
t0: [14:00:00 02/12/2015] id: Urine Out Condom Cath el: 1 cu: CCU cg: RN vo: 10 vu: ml t0: [16:00:00 02/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 180 vu: ml t0: [16:00:00 02/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 0 vu: ml
t0: [17:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [17:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 67 u1: BPM st: NotStopd t0: [17:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 130 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [17:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 96.6667 u1: mmHg st: NotStopd t0: [17:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 34 u1: BPM st: NotStopd t0: [17:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [17:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 02/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 180 vu: ml t0: [17:00:00 02/12/2015] id: Urine Out Condom Cath el: 1 cu: CCU cg: RN vo: 125 vu: ml
t0: [23:00:00 02/12/2015] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN cv: 0 ap: none t0: [23:00:00 02/12/2015] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN cv: 535 ap: none t0: [23:00:00 02/12/2015] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN cv: 835.5 ap: carryForward
t0: [20:00:00 02/12/2015] id: CVP el: 0 cu: CCU cg: -1 st: D/C'd
t0: [19:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [19:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [19:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 135 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [19:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 94.3333 u1: mmHg st: NotStopd t0: [19:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [19:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 24 u1: BPM st: NotStopd t0: [19:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [20:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 02/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 02/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [20:00:00 02/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [20:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 02/12/2015] id: IV #1 Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 3 st: NotStopd t0: [20:00:00 02/12/2015] id: IV #1 Site/Size el: 0 cu: CCU cg: RN v1: LL Post Forearm v2: 20 gauge st: NotStopd t0: [20:00:00 02/12/2015] id: IV Site Appear #1 el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 143 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [20:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [20:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 35 u1: BPM st: NotStopd t0: [20:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [20:00:00 02/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [20:00:00 02/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.5556 u1: Deg. C st: NotStopd t0: [20:00:00 02/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 96 u1: Deg. F st: NotStopd t0: [20:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 02/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 120 vu: ml
t0: [20:00:00 02/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 02/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: NAS/Low Cholest st: NotStopd t0: [20:00:00 02/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 02/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [20:00:00 02/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 02/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 02/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 02/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 02/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [20:00:00 02/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 02/12/2015] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 02/12/2015] id: LLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [20:00:00 02/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 02/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 02/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [20:00:00 02/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [20:00:00 02/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 02/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [20:00:00 02/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 02/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 02/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [20:00:00 02/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [20:00:00 02/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [20:00:00 02/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 02/12/2015] id: Assistance Device el: 0 cu: CCU cg: RN v1: 1 Person Assist st: NotStopd t0: [20:00:00 02/12/2015] id: RLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [20:00:00 02/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [20:00:00 02/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [20:00:00 02/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [20:00:00 02/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 02/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 02/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [20:00:00 02/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 02/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 02/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 02/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Condom Catheter st: NotStopd t0: [20:00:00 02/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 02/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Calm st: NotStopd t0: [20:00:00 02/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [20:00:00 02/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 02/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 02/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 02/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Rarely Moist st: NotStopd t0: [20:00:00 02/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 02/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 15 u1: number st: NotStopd t0: [20:00:00 02/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Sl. Limited st: NotStopd t0: [21:00:00 02/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [21:00:00 02/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [21:00:00 02/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 02/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 02/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 02/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 75 u1: BPM st: NotStopd t0: [21:00:00 02/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 02/12/2015] id: NBP el: 0 cu: CCU cg: RN v1: 136 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [21:00:00 02/12/2015] id: NBP Mean el: 0 cu: CCU cg: RN v1: 94.6667 u1: mmHg st: NotStopd t0: [21:00:00 02/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 02/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [21:00:00 02/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [21:00:00 02/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [21:00:00 02/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [21:00:00 02/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
tf: [16:00:00 04/12/2015] pt: Unit Dose rt: SC fr: Q12H fs: 20, 8 dn: 2 m1: Enoxaparin Sodium v1: 50 u1: mg
tf: [18:00:00 05/12/2015] pt: Unit Dose rt: PO fr: Q8H fs: 16, 0, 8 dn: 3 m1: Amoxicillin-Clavulanic Acid v1: 500 u1: mg
tf: [17:00:00 05/12/2015] pt: Unit Dose rt: PO fr: Q12H fs: 18, 6 dn: 2 m1: Voriconazole v1: 400 u1: mg
tf: [16:00:00 04/12/2015] pt: Unit Dose rt: SC fr: Q12H fs: 20, 8 dn: 2 m1: Enoxaparin Sodium v1: 50 u1: mg tf: [07:00:00 08/12/2015] pt: Unit Dose rt: SC fr: Q12H fs: 20, 8 dn: 2 m1: Enoxaparin Sodium v1: 50 u1: mg
tf: [13:00:00 23/12/2015] pt: Unit Dose rt: PO fr: Q12H fs: 18, 6 dn: 2 m1: Voriconazole v1: 200 u1: mg
tf: [14:00:00 06/12/2015] pt: IV Piggyback rt: IV fr: Q8H fs: 21, 5, 13 dn: 3 m1: Piperacillin-Tazobactam Na v1: 4.5 u1: gm m2: Iso-Osmotic Dextrose v2: 100 u2: ml
tf: [16:00:00 06/12/2015] pt: IV Piggyback rt: IV fr: Q6H fs: 15, 21, 3, 9 dn: 4 m1: Piperacillin-Tazobactam Na v1: 2.25 u1: gm m2: Iso-Osmotic Dextrose v2: 50 u2: ml
tf: [10:00:00 09/12/2015] pt: IV Piggyback rt: IV fr: Q8H fs: 0, 8, 16 dn: 3 m1: Unasyn v1: 3 u1: gm m2: NS v2: 100 u2: ml
tf: [02:00:00 09/12/2015] pt: Unit Dose rt: SC fr: Q12H fs: 20, 8 dn: 2 m1: Enoxaparin Sodium v1: 50 u1: mg
tf: [16:00:00 09/12/2015] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Thiamine HCl v1: 100 u1: mg tf: [19:00:00 17/12/2015] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Lisinopril v1: 5 u1: mg tf: [22:00:00 25/12/2015] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Multivitamins v1: 1 u1: CAP tf: [23:00:00 28/12/2015] pt: Unit Dose rt: IV fr: QD fs: 10 dn: 1 m1: Thiamine HCl v1: 100 u1: mg
tf: [13:00:00 23/12/2015] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Amoxicillin-Clavulanic Acid v1: 500 u1: mg
tf: [16:00:00 16/12/2015] pt: Unit Dose rt: SC fr: Q12H fs: 20, 8 dn: 2 m1: Enoxaparin Sodium v1: 50 u1: mg
tf: [21:00:00 10/12/2015] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Magnesium Oxide v1: 400 u1: mg tf: [11:00:00 11/12/2015] pt: Unit Dose rt: PO fr: HS fs: 22 dn: 1 m1: Mirtazapine v1: 7.5 u1: mg
tf: [02:00:00 12/12/2015] pt: Unit Dose rt: PO fr: HS:PRN m1: Zolpidem Tartrate v1: 5-10 u1: mg
tf: [14:00:00 12/12/2015] pt: Unit Dose rt: IV fr: ONCE fs: 15 dn: 1 m1: Flumazenil v1: 0.25 u1: mg
tf: [12:00:00 14/12/2015] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 50 u1: mg
tf: [17:00:00 14/12/2015] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Furosemide v1: 20 u1: mg
tf: [14:00:00 16/01/2016] pt: Unit Dose rt: PO fr: HS:PRN m1: Diphenhydramine HCl v1: 12.5-25 u1: mg
tf: [09:00:00 14/12/2015] pt: IV Piggyback rt: IV fr: ONCE fs: 10 dn: 1 m1: Sodium Phosphate v1: 15 u1: mmol m2: NS v2: 250 u2: ml tf: [10:00:00 14/12/2015] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Magnesium Oxide v1: 400 u1: mg
tf: [17:00:00 18/12/2015] pt: Unit Dose rt: PO fr: TID W/MEALS fs: 08, 12, 17 dn: 3 m1: Calcium Carbonate v1: 500 u1: mg
tf: [11:00:00 15/12/2015] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 37.5 u1: mg
tf: [17:00:00 16/12/2015] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Furosemide v1: 40 u1: mg
tf: [11:00:00 16/12/2015] pt: Unit Dose rt: PO fr: ONCE fs: 12 dn: 1 m1: Sodium Polystyrene Sulfonate v1: 30 u1: gm tf: [13:00:00 23/12/2015] pt: Unit Dose rt: PO fr: HS:PRN m1: Lorazepam v1: 0.5 u1: mg
tf: [17:00:00 18/12/2015] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 25 u1: mg
tf: [01:00:00 05/01/2016] pt: Unit Dose rt: IV fr: ASDIR m1: Atropine Sulfate v1: 1 u1: AMP
tf: [14:00:00 21/12/2015] pt: Unit Dose rt: SC fr: Q12H fs: 16, 4 dn: 2 m1: Enoxaparin Sodium v1: 50 u1: mg
tf: [08:00:00 18/12/2015] pt: Unit Dose rt: IV fr: ONCE fs: 0 dn: 1 m1: Bumetanide v1: 1 u1: mg
tf: [14:00:00 19/12/2015] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Furosemide v1: 20 u1: mg tf: [14:00:00 21/12/2015] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metoprolol v1: 37.5 u1: mg
tf: [11:00:00 31/01/2016] pt: IV Piggyback rt: SC fr: 3X/WEEK fs: 10 m1: Epoetin Alfa v1: 2000 u1: UNIT m2: Vial v2: 1 u2: VIAL tf: [11:00:00 02/02/2016] pt: IV Piggyback rt: SC fr: 3X/WEEK fs: 10 m1: Epoetin Alfa v1: 3000 u1: UNIT m2: Vial v2: 1 u2: VIAL
tf: [09:00:00 21/12/2015] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Captopril v1: 6.25 u1: mg
tf: [14:00:00 21/12/2015] pt: Unit Dose rt: IV fr: BID fs: 10, 22 dn: 2 m1: Furosemide v1: 20 u1: mg
tf: [23:00:00 20/12/2015] pt: Unit Dose rt: TP fr: ONCE fs: 0 dn: 1 m1: Benzocaine 20% Spray v1: 1 u1: SPRY
tf: [14:00:00 21/12/2015] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: DopAmine v1: 400 u1: mg m2: D5W v2: 250 u2: ml
tf: [14:00:00 21/12/2015] pt: Unit Dose rt: IV fr: ONCE fs: 0 dn: 1 m1: Furosemide v1: 20 u1: mg
tf: [14:00:00 21/12/2015] pt: Unit Dose rt: PO fr: ONCE fs: 10 dn: 1 m1: Sodium Polystyrene Sulfonate v1: 30 u1: gm
tf: [11:19:00 21/12/2015] dt: 32 cu: CCU de: FA2 di: Other
id: Dopamine el: 100 cu: CCU cg: RN io: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions am: 400 du: mcgkgmin rt: IV Drip
t0: [14:00:00 21/12/2015] id: IV #1 Reason DC'D el: 0 cu: CCU cg: -1 st: D/C'd t0: [14:00:00 21/12/2015] id: IV #2 Reason DC'D el: 0 cu: CCU cg: -1 st: D/C'd t0: [14:00:00 21/12/2015] id: IV #1 D/C Date el: 0 cu: CCU cg: -1 st: D/C'd t0: [14:00:00 21/12/2015] id: IV #1 Insert Date el: 0 cu: CCU cg: -1 st: D/C'd t0: [14:00:00 21/12/2015] id: IV #1 Site/Size el: 0 cu: CCU cg: -1 st: D/C'd t0: [14:00:00 21/12/2015] id: IV #2 D/C Date el: 0 cu: CCU cg: -1 st: D/C'd t0: [14:00:00 21/12/2015] id: IV #2 Insert Date el: 0 cu: CCU cg: -1 st: D/C'd t0: [14:00:00 21/12/2015] id: IV #2 Site/Size el: 0 cu: CCU cg: -1 st: D/C'd t0: [14:00:00 21/12/2015] id: IV Site Appear #1 el: 0 cu: CCU cg: -1 st: D/C'd
io: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ra: 12.375 ru: ml/hr
t0: [14:00:00 21/12/2015] id: Drain Out #1 Pericardial el: 1 cu: CCU cg: -1 vo: 0 st: D/C'd t0: [14:00:00 21/12/2015] id: Urine Out Condom Cath el: 1 cu: CCU cg: -1 vo: 0 st: D/C'd
id: D5W el: 1 cu: CCU cg: RN io: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions vo: 250 du: ml rt: Intravenous Push id: .9% Normal Saline el: 2 cu: CCU cg: RN io: .9% Normal Saline 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push id: Cath Lab Intake el: 2 cu: CCU cg: RN io: Cath Lab Intake Cath Lab Intake du: ml rt: Intravenous Push
tf: [10:28:00 23/12/2015] dt: 2653 cu: CCU de: CC1B
t0: [14:00:00 21/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [14:00:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [14:00:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 21/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 21/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [14:00:00 21/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 101 u1: BPM st: NotStopd t0: [14:00:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 21/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: Nasal Cannula st: NotStopd t0: [14:00:00 21/12/2015] id: O2 Flow (lpm) el: 0 cu: CCU cg: RN v1: 3 u1: lpm st: NotStopd t0: [14:00:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 23 u1: mmHg st: NotStopd t0: [14:00:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 31 u1: mmHg v2: 19 u2: mmHg st: NotStopd t0: [14:00:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 71 u1: mmHg v2: 43 u2: mmHg st: NotStopd t0: [14:00:00 21/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [14:00:00 21/12/2015] id: Pain Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 52 u1: mmHg st: NotStopd t0: [14:00:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:00:00 21/12/2015] id: Previous Weight el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [14:00:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [14:00:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 11 u1: BPM st: NotStopd t0: [14:00:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 93 u1: % st: NotStopd t0: [14:00:00 21/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [14:00:00 21/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.4444 u1: Deg. C st: NotStopd t0: [14:00:00 21/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 95.8 u1: Deg. F st: NotStopd t0: [14:00:00 21/12/2015] id: Weight Change el: 0 cu: CCU cg: RN v1: 0 u1: kg st: NotStopd t0: [14:00:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 21/12/2015] id: Daily Weight el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd
t0: [14:20:00 21/12/2015] id: BSA el: 1033 cu: CCU cg: -1 v1: 1.71063 u1: m2 t0: [14:20:00 21/12/2015] id: Admit Wt el: 1032 cu: CCU cg: -1 v1: 66 u1: kg t0: [14:20:00 21/12/2015] id: Allergy 1 el: 1020 cu: CCU cg: -1 t0: [14:20:00 21/12/2015] id: Diagnosis/op el: 1023 cu: CCU cg: -1 v1: CONGESTIVE HEART FAILURE;TELEMETRY t0: [14:20:00 21/12/2015] id: Service el: 1026 cu: CCU cg: -1 v1: CME t0: [14:20:00 21/12/2015] id: Admit Ht el: 1034 cu: CCU cg: -1 v1: 59 u1: inches t0: [14:20:00 21/12/2015] id: Readmission el: 1014 cu: CCU cg: -1 t0: [14:20:00 21/12/2015] id: Marital Status el: 1006 cu: CCU cg: -1 v1: M t0: [14:20:00 21/12/2015] id: Religion el: 1000 cu: CCU cg: -1 v1: NSP t0: [14:20:00 21/12/2015] id: Allergy 2 el: 1021 cu: CCU cg: -1 t0: [14:20:00 21/12/2015] id: Ext el: 1010 cu: CCU cg: -1 t0: [14:20:00 21/12/2015] id: PIN el: 1012 cu: CCU cg: -1 t0: [14:20:00 21/12/2015] id: Allergy 3 el: 1022 cu: CCU cg: -1
t0: [14:00:00 21/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 21/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Weak st: NotStopd t0: [14:00:00 21/12/2015] id: Cough Type el: 0 cu: CCU cg: RN v1: Nonproductive st: NotStopd t0: [14:00:00 21/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [14:00:00 21/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [14:00:00 21/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [14:00:00 21/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [14:00:00 21/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 21/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Family Visited st: NotStopd t0: [14:00:00 21/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [14:00:00 21/12/2015] id: GI Intub #1/Site el: 0 cu: CCU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [14:00:00 21/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [14:00:00 21/12/2015] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 21/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v2: ? st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#2 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#3 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [14:00:00 21/12/2015] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [14:00:00 21/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [14:00:00 21/12/2015] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 21/12/2015] id: INV#3 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 21/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 21/12/2015] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 21/12/2015] id: LLE Temp/Color el: 0 cu: CCU cg: RN v1: Cool v2: Normal st: NotStopd t0: [14:00:00 21/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 21/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [14:00:00 21/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [14:00:00 21/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [14:00:00 21/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 21/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [14:00:00 21/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 21/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [14:00:00 21/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [14:00:00 21/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [14:00:00 21/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [14:00:00 21/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [14:00:00 21/12/2015] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 21/12/2015] id: RLE Temp/Color el: 0 cu: CCU cg: RN v1: Cool v2: Pale st: NotStopd t0: [14:00:00 21/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [14:00:00 21/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [14:00:00 21/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Normal st: NotStopd t0: [14:00:00 21/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [14:00:00 21/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 21/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 21/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [14:00:00 21/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Significnt Other st: NotStopd t0: [14:00:00 21/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Logroll st: NotStopd t0: [14:00:00 21/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 21/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 21/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [14:00:00 21/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Calm st: NotStopd t0: [14:00:00 21/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [14:00:00 21/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [14:00:00 21/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [14:00:00 21/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [14:00:00 21/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Rarely Moist st: NotStopd t0: [14:00:00 21/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [14:00:00 21/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [14:00:00 21/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Comp. Limited st: NotStopd t0: [14:00:00 21/12/2015] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [14:00:00 21/12/2015] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 21/12/2015] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 21/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 21/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [14:15:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:15:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:15:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:15:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:15:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 110 u1: BPM st: NotStopd t0: [14:15:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:15:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 25 u1: mmHg st: NotStopd t0: [14:15:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 40 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [14:15:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 90 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [14:15:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [14:15:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:15:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [14:15:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 13 u1: BPM st: NotStopd t0: [14:15:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 93 u1: % st: NotStopd t0: [14:15:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:15:00 21/12/2015] tf: [10:00:00 22/12/2015] dt: 1185 id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 0 vu: ml nb: 1 t0: [14:00:00 21/12/2015] id: Cath Lab Intake Cath Lab Intake el: 2 cu: CCU cg: RN ai: 1159 vu: ml t0: [14:15:00 21/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 3.09375 vu: ml
t0: [14:00:00 21/12/2015] tf: [10:00:00 22/12/2015] dt: 1200 id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:15:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 8 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [14:30:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [14:30:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:30:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:30:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:30:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:30:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 113 u1: BPM st: NotStopd t0: [14:30:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:30:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [14:30:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 41 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [14:30:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 89 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [14:30:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [14:30:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:30:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [14:30:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 17 u1: BPM st: NotStopd t0: [14:30:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [14:30:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [15:00:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [15:00:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 122 u1: BPM st: NotStopd t0: [15:00:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:00:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 32 u1: mmHg st: NotStopd t0: [15:00:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 46 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [15:00:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 110 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [15:00:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [15:00:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [15:00:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [15:00:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 20 u1: BPM st: NotStopd t0: [15:00:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 74 u1: % st: NotStopd t0: [15:00:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 21/12/2015] tf: [10:28:00 23/12/2015] dt: 2608 id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 30 vu: ml t0: [15:00:00 21/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 14.85 vu: ml t0: [15:00:00 21/12/2015] tf: [01:00:00 23/12/2015] dt: 2040 id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 100 vu: ml
t0: [14:30:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 8 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 6 du: mcgkgmin sv: 250 su: ml rt: IV Drip
tf: [02:00:00 23/12/2015] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: DopAmine v1: 400 u1: mg m2: D5W v2: 250 u2: ml tf: [13:00:00 23/12/2015] pt: IV Piggyback rt: IV fr: ASDIR m1: Heparin Sodium v1: 25000 u1: UNIT m2: D5W v2: 250 u2: ml tf: [13:00:00 23/12/2015] pt: Unit Dose rt: IV fr: ONCE fs: 15 dn: 1 m1: Heparin v1: 4500 u1: UNIT
t0: [15:30:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [15:30:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [15:30:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [15:30:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:30:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:30:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 120 u1: BPM st: NotStopd t0: [15:30:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:30:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [15:30:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 47 u1: mmHg v2: 29 u2: mmHg st: NotStopd t0: [15:30:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 96 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [15:30:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [15:30:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [15:30:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [15:30:00 21/12/2015] id: Procedures el: 0 cu: CCU cg: RN v1: Cardiac Echo st: NotStopd t0: [15:30:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [15:30:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 85 u1: % st: NotStopd t0: [15:30:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:30:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
io: Nepro Tube Feeding el: 1 cu: CCU cg: RN ra: 20 ru: ml/hr
id: Nepro el: 1 cu: CCU cg: RN io: Nepro Tube Feeding du: str rt: Gastric/Feeding Tube
t0: [16:30:00 21/12/2015] id: Pain Level el: 0 cu: CCU cg: RN v1: 0-None st: NotStopd t0: [16:30:00 21/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [16:30:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [16:30:00 21/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [16:30:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [16:30:00 21/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:30:00 21/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Weak st: NotStopd t0: [16:30:00 21/12/2015] id: Cough Type el: 0 cu: CCU cg: RN v1: Nonproductive st: NotStopd t0: [16:30:00 21/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:30:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:30:00 21/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [16:30:00 21/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [16:30:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:30:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:30:00 21/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [16:30:00 21/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:30:00 21/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Family Visited st: NotStopd t0: [16:30:00 21/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [16:30:00 21/12/2015] id: GI Intub #1/Site el: 0 cu: CCU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:30:00 21/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [16:30:00 21/12/2015] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [16:30:00 21/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [16:30:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 122 u1: BPM st: NotStopd t0: [16:30:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v2: ? st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#2 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#3 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [16:30:00 21/12/2015] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [16:30:00 21/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [16:30:00 21/12/2015] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [16:30:00 21/12/2015] id: INV#3 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [16:30:00 21/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [16:30:00 21/12/2015] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [16:30:00 21/12/2015] id: KneeImmobilizer/Loc el: 0 cu: CCU cg: RN v1: Off v2: Right Knee st: NotStopd t0: [16:30:00 21/12/2015] id: LLE Temp/Color el: 0 cu: CCU cg: RN v1: Cold v2: Pale st: NotStopd t0: [16:30:00 21/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [16:30:00 21/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [16:30:00 21/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [16:30:00 21/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [16:30:00 21/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:30:00 21/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [16:30:00 21/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: Nasal Cannula st: NotStopd t0: [16:30:00 21/12/2015] id: O2 Flow (lpm) el: 0 cu: CCU cg: RN v1: 3 u1: lpm st: NotStopd t0: [16:30:00 21/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:30:00 21/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:30:00 21/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [16:30:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [16:30:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 40 u1: mmHg v2: 29 u2: mmHg st: NotStopd t0: [16:30:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 110 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [16:30:00 21/12/2015] id: Pain Level (Rest) el: 0 cu: CCU cg: RN v1: 0-None st: NotStopd t0: [16:30:00 21/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [16:30:00 21/12/2015] id: Pain Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:30:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [16:30:00 21/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [16:30:00 21/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [16:30:00 21/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [16:30:00 21/12/2015] id: Assistance Device el: 0 cu: CCU cg: RN v1: 1 Person Assist st: NotStopd t0: [16:30:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [16:30:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [16:30:00 21/12/2015] id: RLE Temp/Color el: 0 cu: CCU cg: RN v1: Cold v2: Pale st: NotStopd t0: [16:30:00 21/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [16:30:00 21/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [16:30:00 21/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Normal st: NotStopd t0: [16:30:00 21/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [16:30:00 21/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:30:00 21/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [16:30:00 21/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [16:30:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 92 u1: % st: NotStopd t0: [16:30:00 21/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Significnt Other st: NotStopd t0: [16:30:00 21/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [16:30:00 21/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.5556 u1: Deg. C st: NotStopd t0: [16:30:00 21/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 96 u1: Deg. F st: NotStopd t0: [16:30:00 21/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Logroll st: NotStopd t0: [16:30:00 21/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow st: NotStopd t0: [16:30:00 21/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:30:00 21/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [16:30:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:30:00 21/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Calm st: NotStopd t0: [16:30:00 21/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [16:30:00 21/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [16:30:00 21/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [16:30:00 21/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [16:30:00 21/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [16:30:00 21/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:30:00 21/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [16:30:00 21/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [16:30:00 21/12/2015] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [16:30:00 21/12/2015] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:30:00 21/12/2015] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [16:30:00 21/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:30:00 21/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [16:30:00 21/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 0 vu: ml nb: 1 t0: [16:30:00 21/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 19.8 vu: ml t0: [16:30:00 21/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 50 vu: ml
t0: [16:30:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 2.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [17:21:00 21/12/2015] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.37 rs: Final st: NotStopd t0: [17:21:00 21/12/2015] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 0 rs: Final st: NotStopd t0: [17:21:00 21/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 28 rs: Final st: NotStopd t0: [17:21:00 21/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 46 u1: mmHg rs: Final st: NotStopd t0: [17:21:00 21/12/2015] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 72 u1: mmHg rs: Final st: NotStopd t0: [17:21:00 21/12/2015] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.37 rs: Final st: NotStopd t0: [17:21:00 21/12/2015] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 94 u1: % rs: Final st: NotStopd
t0: [17:26:00 21/12/2015] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CCU cg: 140 v1: 44 rs: Final st: NotStopd
t0: [17:00:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [17:00:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [17:00:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 118 u1: BPM st: NotStopd t0: [17:00:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 33 u1: mmHg st: NotStopd t0: [17:00:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 41 u1: mmHg v2: 26 u2: mmHg st: NotStopd t0: [17:00:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 97 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [17:00:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [17:00:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:00:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [17:00:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 23 u1: BPM st: NotStopd t0: [17:00:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 21/12/2015] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CCU cg: RN v1: 44 rs: Manual st: NotStopd t0: [17:00:00 21/12/2015] id: SaO2 ABG's el: 0 cu: CCU cg: RN v1: 94 u1: % rs: Manual st: NotStopd t0: [17:30:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [17:30:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:30:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [17:30:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 103 u1: BPM st: NotStopd t0: [17:30:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:30:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 25 u1: mmHg st: NotStopd t0: [17:30:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 35 u1: mmHg v2: 20 u2: mmHg st: NotStopd t0: [17:30:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 83 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [17:30:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [17:30:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:30:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [17:30:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 25 u1: BPM st: NotStopd t0: [17:30:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 93 u1: % st: NotStopd t0: [17:30:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [18:00:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [18:00:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 118 u1: BPM st: NotStopd t0: [18:00:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [18:00:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 42 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [18:00:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 91 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [18:00:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [18:00:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:00:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [18:00:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 13 u1: BPM st: NotStopd t0: [18:00:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 91 u1: % st: NotStopd t0: [18:00:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:30:00 21/12/2015] tf: [10:28:00 23/12/2015] dt: 2518 id: Chest Tubes Left Pleural 1 el: 1 cu: CCU cg: RN vo: 25 vu: ml t0: [18:00:00 21/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 100 vu: ml t0: [18:00:00 21/12/2015] tf: [10:28:00 23/12/2015] dt: 2428 id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 10 vu: ml t0: [18:00:00 21/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 11.1375 vu: ml t0: [18:00:00 21/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 0 vu: ml nb: 1 t0: [18:00:00 21/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 20 vu: ml
t0: [17:00:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 2.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:30:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
id: Heparin el: 100 cu: CCU cg: RN io: D5W 250.0ml + 25000Uhr Heparin IV Infusions am: 25000 du: Uhr rt: IV Drip
tf: [13:00:00 23/12/2015] pt: Unit Dose rt: PO fr: PRN m1: Cetylpyridinium Chl (Cepacol) v1: 1 u1: LOZ
id: D5W el: 1 cu: CCU cg: RN io: D5W 250.0ml + 25000Uhr Heparin IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [17:30:00 21/12/2015] id: Previous Weight el: 0 cu: CCU cg: 140 v1: 66 u1: kg st: NotStopd t0: [17:33:00 21/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 10.3 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 10.3 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 28.4 u1: % rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 8.5 u1: gm/dl rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 671 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 3.07 u1: /mic l rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 10.3 rs: Final st: NotStopd t0: [18:00:00 21/12/2015] id: Previous Weight el: 0 cu: CCU cg: 140 v1: 66 u1: kg st: NotStopd
t0: [23:00:00 21/12/2015] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: 140 cv: 130 ap: none
t0: [17:33:00 21/12/2015] id: BUN el: 0 cu: CCU cg: 140 v1: 65 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 99 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 1.6 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 128 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 5.4 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 132 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 65 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 25 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 99 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 1.6 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 128 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 5.4 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 132 rs: Final st: NotStopd
t0: [17:33:00 21/12/2015] id: PT el: 0 cu: CCU cg: 140 v1: 14.2 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: INR Coags el: 0 cu: CCU cg: 140 v1: 1.3 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: PTT Coags el: 0 cu: CCU cg: 140 v1: 35.4 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CCU cg: 140 v1: 1.3 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: PT(11-13.5) Coags el: 0 cu: CCU cg: 140 v1: 14.2 rs: Final st: NotStopd t0: [17:33:00 21/12/2015] id: PTT(22-35) Coags el: 0 cu: CCU cg: 140 v1: 35.4 rs: Final st: NotStopd
t0: [17:00:00 21/12/2015] id: Hemoglobin Hematology el: 0 cu: CCU cg: RN v1: 8.5 u1: gm/dl rs: Manual st: NotStopd t0: [17:00:00 21/12/2015] id: C.O. (fick) el: 0 cu: CCU cg: RN v1: 3.75329 u1: L/min st: NotStopd t0: [17:21:00 21/12/2015] id: CaO2 el: 0 cu: CCU cg: RN v1: 10.9298 u1: ml/dl st: NotStopd t0: [17:26:00 21/12/2015] id: C.O. (fick) el: 0 cu: CCU cg: RN v1: 3.75329 u1: L/min st: NotStopd t0: [17:30:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:30:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 21/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [18:00:00 21/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd
t0: [19:00:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [19:00:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [19:00:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 122 u1: BPM st: NotStopd t0: [19:00:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 32 u1: mmHg st: NotStopd t0: [19:00:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 48 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [19:00:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 98 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [19:00:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [19:00:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [19:00:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [19:00:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 15 u1: BPM st: NotStopd t0: [19:00:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [19:00:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 21/12/2015] tf: [10:28:00 23/12/2015] dt: 2368 id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [19:00:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [20:00:00 21/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [20:00:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [20:00:00 21/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 21/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 21/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Weak st: NotStopd t0: [20:00:00 21/12/2015] id: Cough Type el: 0 cu: CCU cg: RN v1: Nonproductive st: NotStopd t0: [20:00:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 21/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 21/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 120 u1: BPM st: NotStopd t0: [20:00:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 21/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 21/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [20:00:00 21/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [20:00:00 21/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry st: NotStopd t0: [20:00:00 21/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 21/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: Nasal Cannula st: NotStopd t0: [20:00:00 21/12/2015] id: O2 Flow (lpm) el: 0 cu: CCU cg: RN v1: 3 u1: lpm st: NotStopd t0: [20:00:00 21/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 21/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [20:00:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [20:00:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 43 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [20:00:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 93 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [20:00:00 21/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [20:00:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:00:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [20:00:00 21/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [20:00:00 21/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [20:00:00 21/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Normal st: NotStopd t0: [20:00:00 21/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [20:00:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [20:00:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [20:00:00 21/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 21/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [20:00:00 21/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 10 vu: ml t0: [20:00:00 21/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 19.8 vu: ml t0: [20:00:00 21/12/2015] tf: [10:28:00 23/12/2015] dt: 2308 id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [20:00:00 21/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 45 vu: ml
t0: [20:00:00 21/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:00:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [18:00:00 21/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 21/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [20:00:00 21/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 21/12/2015] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 21/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 21/12/2015] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 21/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [20:00:00 21/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [20:00:00 21/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [20:00:00 21/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Logroll st: NotStopd
t0: [22:00:00 21/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [22:00:00 21/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 21/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:00:00 21/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 21/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 21/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 121 u1: BPM st: NotStopd t0: [22:00:00 21/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 21/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [22:00:00 21/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 45 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [22:00:00 21/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 94 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [22:00:00 21/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [22:00:00 21/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:00:00 21/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [22:00:00 21/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [22:00:00 21/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [22:00:00 21/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 21/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 10 vu: ml t0: [22:00:00 21/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 19.8 vu: ml t0: [22:00:00 21/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [22:00:00 21/12/2015] id: Chest Tubes Left Pleural 1 el: 1 cu: CCU cg: RN vo: 2 vu: ml t0: [22:00:00 21/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 40 vu: ml
t0: [22:00:00 21/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [22:00:00 21/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 21/12/2015] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN cv: 0 ap: none t0: [23:00:00 21/12/2015] dt: 24 id: Tube Feeds In Total el: 1 cu: CCU cg: RN cv: 80 ap: none t0: [23:00:00 21/12/2015] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN cv: 255 ap: none t0: [23:00:00 21/12/2015] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN cv: 282 ap: none t0: [23:00:00 21/12/2015] dt: 24 id: Chest Tube Out Total el: 1 cu: CCU cg: RN cv: 27 ap: none
t0: [22:00:00 21/12/2015] tf: [04:00:00 23/12/2015] dt: 1800 id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 0 vu: ml nb: 1 t0: [22:00:00 21/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 30 vu: ml
t0: [23:00:00 21/12/2015] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN cv: 0 ap: none t0: [23:00:00 21/12/2015] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN cv: 148.481 ap: none t0: [23:00:00 21/12/2015] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN cv: 358.481 ap: none t0: [23:00:00 21/12/2015] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN cv: 76.4812 ap: none t0: [23:00:00 21/12/2015] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN cv: 76.4812 ap: none
t0: [00:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [00:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 122 u1: BPM st: NotStopd t0: [00:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 32 u1: mmHg st: NotStopd t0: [00:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 50 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [00:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 107 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [00:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [00:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [00:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 11 u1: BPM st: NotStopd t0: [00:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 22/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [00:00:00 22/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [00:00:00 22/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [00:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [00:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [01:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [01:00:00 22/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [01:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 22/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Weak st: NotStopd t0: [01:00:00 22/12/2015] id: Cough Type el: 0 cu: CCU cg: RN v1: Nonproductive st: NotStopd t0: [01:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:00:00 22/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [01:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 22/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [01:00:00 22/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [01:00:00 22/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [01:00:00 22/12/2015] id: GI Intub #1/Site el: 0 cu: CCU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [01:00:00 22/12/2015] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [01:00:00 22/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [01:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 120 u1: BPM st: NotStopd t0: [01:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 22/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 22/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 22/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [01:00:00 22/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [01:00:00 22/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry st: NotStopd t0: [01:00:00 22/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [01:00:00 22/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [01:00:00 22/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [01:00:00 22/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [01:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [01:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 50 u1: mmHg v2: 27 u2: mmHg st: NotStopd t0: [01:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 100 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [01:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [01:00:00 22/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [01:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [01:00:00 22/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 22/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [01:00:00 22/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Normal st: NotStopd t0: [01:00:00 22/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [01:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 9 u1: BPM st: NotStopd t0: [01:00:00 22/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 22/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [01:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [01:00:00 22/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Significnt Other st: NotStopd t0: [01:00:00 22/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Logroll st: NotStopd t0: [01:00:00 22/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [01:00:00 22/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 22/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [01:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 22/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [01:00:00 22/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [01:00:00 22/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [01:00:00 22/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [01:00:00 22/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [01:00:00 22/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 14 u1: number st: NotStopd t0: [01:00:00 22/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: No Impairment st: NotStopd t0: [01:00:00 22/12/2015] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [01:00:00 22/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [01:00:00 22/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [01:00:00 22/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 100 vu: ml t0: [01:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 15 vu: ml t0: [01:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 30 vu: ml t0: [01:00:00 22/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 29.7 vu: ml t0: [01:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 60 vu: ml t0: [01:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 100 vu: ml
t0: [01:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [01:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 22/12/2015] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: RN cv: 590 ap: none
t0: [06:00:00 21/12/2015] id: Albumin Chemistry el: 0 cu: CCU cg: 140 v1: 2.2 rs: Final st: NotStopd t0: [06:00:00 21/12/2015] id: Total Bili Chemistry el: 0 cu: CCU cg: 140 v1: 0.3 rs: Final st: NotStopd t0: [06:00:00 21/12/2015] id: AST Enzymes el: 0 cu: CCU cg: 140 v1: 28 rs: Final st: NotStopd t0: [06:00:00 21/12/2015] id: Albumin (>3.2) Chemistry el: 0 cu: CCU cg: 140 v1: 2.2 rs: Final st: NotStopd t0: [06:00:00 21/12/2015] id: Alk. Phosphate Enzymes el: 0 cu: CCU cg: 140 v1: 234 rs: Final st: NotStopd t0: [06:00:00 21/12/2015] id: LDH Enzymes el: 0 cu: CCU cg: 140 v1: 212 rs: Final st: NotStopd t0: [06:00:00 21/12/2015] id: Total Bili (0-1.5) Chemistry el: 0 cu: CCU cg: 140 v1: 0.3 rs: Final st: NotStopd
t0: [01:09:00 22/12/2015] id: PTT Coags el: 0 cu: CCU cg: 140 v1: 50 rs: Final st: NotStopd t0: [01:09:00 22/12/2015] id: PTT(22-35) Coags el: 0 cu: CCU cg: 140 v1: 50 rs: Final st: NotStopd
t0: [02:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 122 u1: BPM st: NotStopd t0: [02:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 33 u1: mmHg st: NotStopd t0: [02:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 50 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [02:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 101 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [02:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [02:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [02:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 22 u1: BPM st: NotStopd t0: [02:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [02:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [00:00:00 22/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: Nasal Cannula st: NotStopd t0: [00:00:00 22/12/2015] id: O2 Flow (lpm) el: 0 cu: CCU cg: RN v1: 3 u1: lpm st: NotStopd t0: [01:00:00 22/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [01:00:00 22/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [02:00:00 22/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Sleeping st: NotStopd t0: [03:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [03:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [03:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 123 u1: BPM st: NotStopd t0: [03:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:00:00 22/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Sleeping st: NotStopd t0: [03:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 33 u1: mmHg st: NotStopd t0: [03:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 48 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [03:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 102 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [03:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [03:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [03:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [03:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [03:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 10 vu: ml t0: [03:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 21 vu: ml t0: [03:00:00 22/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 19.8 vu: ml t0: [03:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [03:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 80 vu: ml
t0: [03:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [03:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 4 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 22/12/2015] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN pv: 70 cv: 70 ap: none t0: [23:00:00 22/12/2015] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN pv: -14 cv: -14 ap: none t0: [23:00:00 22/12/2015] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN pv: 16 cv: 497.475 ap: none t0: [23:00:00 22/12/2015] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN pv: 56 cv: 1887.47 ap: none t0: [23:00:00 22/12/2015] dt: 24 id: Tube Feeds In Total el: 1 cu: CCU cg: RN pv: 40 cv: 800 ap: none t0: [23:00:00 22/12/2015] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN pv: 70 cv: 1094 ap: none t0: [23:00:00 22/12/2015] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN pv: -14 cv: 793.475 ap: carryForward t0: [23:00:00 22/12/2015] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN pv: 70 cv: 1094 ap: carryForward t0: [23:00:00 22/12/2015] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN pv: -14 cv: 869.956 ap: carryForward
t0: [04:00:00 22/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [04:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 22/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 22/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [04:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 124 u1: BPM st: NotStopd t0: [04:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 22/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 22/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v2: ? st: NotStopd t0: [04:00:00 22/12/2015] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [04:00:00 22/12/2015] id: INV Line#2 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 22/12/2015] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [04:00:00 22/12/2015] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 22/12/2015] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [04:00:00 22/12/2015] id: INV Line#3 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 22/12/2015] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [04:00:00 22/12/2015] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 22/12/2015] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 22/12/2015] id: INV#3 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 22/12/2015] id: KneeImmobilizer/Loc el: 0 cu: CCU cg: RN v1: Off st: NotStopd t0: [04:00:00 22/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 22/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [04:00:00 22/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [04:00:00 22/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [04:00:00 22/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 22/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: Nasal Cannula st: NotStopd t0: [04:00:00 22/12/2015] id: O2 Flow (lpm) el: 0 cu: CCU cg: RN v1: 3 u1: lpm st: NotStopd t0: [04:00:00 22/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [04:00:00 22/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [04:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 40 u1: mmHg st: NotStopd t0: [04:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 55 u1: mmHg v2: 30 u2: mmHg st: NotStopd t0: [04:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 108 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [04:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [04:00:00 22/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:00:00 22/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 22/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [04:00:00 22/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [04:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 27 u1: BPM st: NotStopd t0: [04:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [04:00:00 22/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [04:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 22/12/2015] id: Stool Out Stool el: 1 cu: CCU cg: RN vu: ml es: Large
t0: [04:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [04:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 22/12/2015] dt: 24 id: Stool Out Total el: 1 cu: CCU cg: RN cv: 0 ap: carryForward
t0: [04:00:00 22/12/2015] id: Hemoglobin Hematology el: 0 cu: CCU cg: RN v1: 8.5 u1: gm/dl rs: Manual st: NotStopd t0: [04:00:00 22/12/2015] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CCU cg: RN v1: 64 rs: Manual st: NotStopd t0: [04:00:00 22/12/2015] id: C.O. (fick) el: 0 cu: CCU cg: RN v1: 5.68681 u1: L/min st: NotStopd
t0: [04:16:00 22/12/2015] id: BSA el: 1033 cu: CCU cg: -1 v1: 1.71063 u1: m2 t0: [04:16:00 22/12/2015] id: Admit Wt el: 1032 cu: CCU cg: -1 v1: 66 u1: kg t0: [04:16:00 22/12/2015] id: Allergy 1 el: 1020 cu: CCU cg: -1 t0: [04:16:00 22/12/2015] id: Diagnosis/op el: 1023 cu: CCU cg: -1 v1: CONGESTIVE HEART FAILURE;TELEMETRY t0: [04:16:00 22/12/2015] id: Service el: 1026 cu: CCU cg: -1 v1: CME t0: [04:16:00 22/12/2015] id: Admit Ht el: 1034 cu: CCU cg: -1 v1: 59 u1: inches t0: [04:16:00 22/12/2015] id: Readmission el: 1014 cu: CCU cg: -1 t0: [04:16:00 22/12/2015] id: Marital Status el: 1006 cu: CCU cg: -1 v1: M t0: [04:16:00 22/12/2015] id: Religion el: 1000 cu: CCU cg: -1 v1: NSP t0: [04:16:00 22/12/2015] id: Allergy 2 el: 1021 cu: CCU cg: -1 t0: [04:16:00 22/12/2015] id: Ext el: 1010 cu: CCU cg: -1 t0: [04:16:00 22/12/2015] id: PIN el: 1012 cu: CCU cg: -1 t0: [04:16:00 22/12/2015] id: Allergy 3 el: 1022 cu: CCU cg: -1
t0: [04:00:00 22/12/2015] id: Stool Color/Consist el: 0 cu: CCU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 22/12/2015] id: Stool Guaiac el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [04:00:00 22/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 22/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [05:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 119 u1: BPM st: NotStopd t0: [05:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 35 u1: mmHg st: NotStopd t0: [05:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 47 u1: mmHg v2: 30 u2: mmHg st: NotStopd t0: [05:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 99 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [05:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [05:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [05:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 16 u1: BPM st: NotStopd t0: [05:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 10 vu: ml t0: [05:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 22 vu: ml t0: [05:00:00 22/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 17.325 vu: ml t0: [05:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [05:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 70 vu: ml
t0: [05:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [05:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [05:11:00 22/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 8.9 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 8.9 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 27 u1: % rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 7.7 u1: gm/dl rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 618 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 2.91 u1: /mic l rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 8.9 rs: Final st: NotStopd
t0: [05:11:00 22/12/2015] id: BUN el: 0 cu: CCU cg: 140 v1: 66 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Albumin Chemistry el: 0 cu: CCU cg: 140 v1: 2.1 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 99 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 1.6 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 134 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 4.6 u1: mEq/L rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 5.1 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 134 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Total Bili Chemistry el: 0 cu: CCU cg: 140 v1: 0.3 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: ALT Enzymes el: 0 cu: CCU cg: 140 v1: 10 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: AST Enzymes el: 0 cu: CCU cg: 140 v1: 21 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Albumin (>3.2) Chemistry el: 0 cu: CCU cg: 140 v1: 2.1 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Alk. Phosphate Enzymes el: 0 cu: CCU cg: 140 v1: 193 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 66 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 28 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 99 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 1.6 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 134 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: LDH Enzymes el: 0 cu: CCU cg: 140 v1: 231 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 4.6 u1: mEq/L rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 5.1 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 134 rs: Final st: NotStopd t0: [05:11:00 22/12/2015] id: Total Bili (0-1.5) Chemistry el: 0 cu: CCU cg: 140 v1: 0.3 rs: Final st: NotStopd
id: GT Flush el: 1 cu: CCU cg: RN io: GT Flush PO/Gastric du: ml rt: Nasogastric
t0: [06:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 121 u1: BPM st: NotStopd t0: [06:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 22/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Sleeping st: NotStopd t0: [06:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [06:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 47 u1: mmHg v2: 28 u2: mmHg st: NotStopd t0: [06:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 97 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [06:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [06:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [06:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 15 u1: BPM st: NotStopd t0: [06:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [06:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [06:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [06:00:00 22/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 7.425 vu: ml t0: [06:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 20 vu: ml t0: [06:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1708 id: GT Flush PO/Gastric el: 1 cu: CCU cg: RN ai: 304 vo: 30 vu: ml t0: [06:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 25 vu: ml
t0: [06:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [06:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [07:00:00 22/12/2015] id: C.O.(thermodilution) el: 0 cu: CCU cg: -1 st: D/C'd
t0: [04:00:00 22/12/2015] id: Cardiac Index el: 0 cu: CCU cg: RN v1: 3.33333 u1: ... st: NotStopd t0: [04:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1828 id: LCW el: 0 cu: CCU cg: RN v1: 6.51168 u1: kg x m st: NotStopd t0: [04:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1828 id: LCWI el: 0 cu: CCU cg: RN v1: 3.80117 u1: ... st: NotStopd t0: [04:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1828 id: LVSW el: 0 cu: CCU cg: RN v1: 52.5504 u1: g * m st: NotStopd t0: [04:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1828 id: LVSWI el: 0 cu: CCU cg: RN v1: 30.9942 u1: g*m/m2 st: NotStopd t0: [04:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1828 id: RCW el: 0 cu: CCU cg: RN v1: 3.1008 u1: kg * m st: NotStopd t0: [04:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1828 id: RCWI el: 0 cu: CCU cg: RN v1: 1.81287 u1: ... st: NotStopd t0: [04:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1828 id: RVSW el: 0 cu: CCU cg: RN v1: 25.024 u1: g * m st: NotStopd t0: [04:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1828 id: RVSWI el: 0 cu: CCU cg: RN v1: 14.6199 u1: g*m/m2 st: NotStopd t0: [04:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1828 id: SVI el: 0 cu: CCU cg: RN v1: 26.9006 u1: ... st: NotStopd t0: [04:00:00 22/12/2015] tf: [10:28:00 23/12/2015] dt: 1828 id: Stroke Volume el: 0 cu: CCU cg: RN v1: 45.9677 u1: ml st: NotStopd t0: [04:00:00 22/12/2015] tf: [07:00:00 22/12/2015] dt: 180 id: C.O.(thermodilution) el: 0 cu: CCU cg: RN v1: 5.7 u1: L/min st: NotStopd
t0: [07:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [07:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [07:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 122 u1: BPM st: NotStopd t0: [07:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:00:00 22/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Sleeping st: NotStopd t0: [07:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 33 u1: mmHg st: NotStopd t0: [07:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 48 u1: mmHg v2: 27 u2: mmHg st: NotStopd t0: [07:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 101 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [07:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [07:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [07:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [07:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 17 u1: BPM st: NotStopd t0: [07:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [07:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 22/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [08:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [08:00:00 22/12/2015] id: Chest PT R/L el: 0 cu: CCU cg: RN v1: Done v2: Done st: NotStopd t0: [08:00:00 22/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 22/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 22/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Weak st: NotStopd t0: [08:00:00 22/12/2015] id: Cough Type el: 0 cu: CCU cg: RN v1: Nonproductive st: NotStopd t0: [08:00:00 22/12/2015] id: Cough/Deep Breathe el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 22/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [08:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 22/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [08:00:00 22/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [08:00:00 22/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 22/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 22/12/2015] id: GI Intub #1/Site el: 0 cu: CCU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 22/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 22/12/2015] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 22/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [08:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 119 u1: BPM st: NotStopd t0: [08:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 22/12/2015] id: Height of Bed el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v2: ? st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#2 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#3 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [08:00:00 22/12/2015] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [08:00:00 22/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [08:00:00 22/12/2015] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 22/12/2015] id: INV#3 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 22/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 22/12/2015] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 22/12/2015] id: KneeImmobilizer/Loc el: 0 cu: CCU cg: RN v1: Off st: NotStopd t0: [08:00:00 22/12/2015] id: LLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [08:00:00 22/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 22/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [08:00:00 22/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Dozing Intermit st: NotStopd t0: [08:00:00 22/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [08:00:00 22/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 22/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [08:00:00 22/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: Nasal Cannula st: NotStopd t0: [08:00:00 22/12/2015] id: O2 Flow (lpm) el: 0 cu: CCU cg: RN v1: 3 u1: lpm st: NotStopd t0: [08:00:00 22/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 22/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:00:00 22/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [08:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 31 u1: mmHg st: NotStopd t0: [08:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 46 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [08:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 100 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [08:00:00 22/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 22/12/2015] id: Pain Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [08:00:00 22/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [08:00:00 22/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 22/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [08:00:00 22/12/2015] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:00:00 22/12/2015] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 22/12/2015] id: Previous Weight el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [08:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [08:00:00 22/12/2015] id: RLE Temp/Color el: 0 cu: CCU cg: RN v1: Warm v2: Normal st: NotStopd t0: [08:00:00 22/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [08:00:00 22/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [08:00:00 22/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Normal st: NotStopd t0: [08:00:00 22/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [08:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 28 u1: BPM st: NotStopd t0: [08:00:00 22/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 22/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 22/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [08:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 91 u1: % st: NotStopd t0: [08:00:00 22/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Significnt Other st: NotStopd t0: [08:00:00 22/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 22/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 22/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 22/12/2015] id: BSA - English el: 0 cu: CCU cg: RN v1: 1.11948 u1: m2 st: NotStopd t0: [08:00:00 22/12/2015] id: BSA - Metric el: 0 cu: CCU cg: RN v1: 1.30932 u1: m2 st: NotStopd t0: [08:00:00 22/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 22/12/2015] id: Weight Change el: 0 cu: CCU cg: RN v1: 0 u1: kg st: NotStopd t0: [08:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 22/12/2015] id: Daily Weight el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [08:00:00 22/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Anxious st: NotStopd t0: [08:00:00 22/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [08:00:00 22/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 22/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 22/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 22/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 22/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Very Poor st: NotStopd t0: [08:00:00 22/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 14 u1: number st: NotStopd t0: [08:00:00 22/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: No Impairment st: NotStopd t0: [08:00:00 22/12/2015] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [08:00:00 22/12/2015] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 22/12/2015] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 22/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 22/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 10 vu: ml t0: [08:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 22 vu: ml t0: [08:00:00 22/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 14.85 vu: ml t0: [08:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 60 vu: ml t0: [08:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 100 vu: ml
t0: [07:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [07:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [08:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [08:35:00 22/12/2015] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.38 rs: Final st: NotStopd t0: [08:35:00 22/12/2015] id: CaO2 el: 0 cu: CCU cg: 140 v1: 10.303 u1: ml/dl st: NotStopd t0: [08:35:00 22/12/2015] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 3 rs: Final st: NotStopd t0: [08:35:00 22/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 32 rs: Final st: NotStopd t0: [08:35:00 22/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 52 u1: mmHg rs: Final st: NotStopd t0: [08:35:00 22/12/2015] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 95 u1: mmHg rs: Final st: NotStopd t0: [08:35:00 22/12/2015] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.38 rs: Final st: NotStopd t0: [08:35:00 22/12/2015] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 97 u1: % rs: Final st: NotStopd
t0: [08:00:00 22/12/2015] id: Cardiac Index el: 0 cu: CCU cg: RN v1: 3.27485 u1: ... st: NotStopd t0: [08:00:00 22/12/2015] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CCU cg: RN v1: 60 rs: Manual st: NotStopd t0: [08:00:00 22/12/2015] id: SaO2 ABG's el: 0 cu: CCU cg: RN v1: 97 u1: % rs: Manual st: NotStopd t0: [08:00:00 22/12/2015] id: C.O. (fick) el: 0 cu: CCU cg: RN v1: 5.59898 u1: L/min st: NotStopd t0: [08:35:00 22/12/2015] id: DO2I el: 0 cu: CCU cg: RN v1: 327 u1: ml/m/m st: NotStopd t0: [09:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [09:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 114 u1: BPM st: NotStopd t0: [09:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [09:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 42 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [09:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 100 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [09:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [09:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [09:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 15 u1: BPM st: NotStopd t0: [09:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [09:00:00 22/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [09:00:00 22/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [09:00:00 22/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [09:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [09:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [09:00:00 22/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 7.425 vu: ml t0: [09:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 30 vu: ml t0: [09:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 26 vu: ml
t0: [09:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [09:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [08:08:00 22/12/2015] id: PT el: 0 cu: CCU cg: 140 v1: 14.4 rs: Final st: NotStopd t0: [08:08:00 22/12/2015] id: INR Coags el: 0 cu: CCU cg: 140 v1: 1.4 rs: Final st: NotStopd t0: [08:08:00 22/12/2015] id: PTT Coags el: 0 cu: CCU cg: 140 v1: 62 rs: Final st: NotStopd t0: [08:08:00 22/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CCU cg: 140 v1: 1.4 rs: Final st: NotStopd t0: [08:08:00 22/12/2015] id: PT(11-13.5) Coags el: 0 cu: CCU cg: 140 v1: 14.4 rs: Final st: NotStopd t0: [08:08:00 22/12/2015] id: PTT(22-35) Coags el: 0 cu: CCU cg: 140 v1: 62 rs: Final st: NotStopd
t0: [09:00:00 22/12/2015] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [09:00:00 22/12/2015] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Expectorated v2: Moderate st: NotStopd
t0: [10:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [10:00:00 22/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [10:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 22/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Strong st: NotStopd t0: [10:00:00 22/12/2015] id: Cough Type el: 0 cu: CCU cg: RN v1: Productive st: NotStopd t0: [10:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:00:00 22/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [10:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 22/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [10:00:00 22/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [10:00:00 22/12/2015] id: GI Intub #1/Site el: 0 cu: CCU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [10:00:00 22/12/2015] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [10:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 115 u1: BPM st: NotStopd t0: [10:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 22/12/2015] id: Height of Bed el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [10:00:00 22/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [10:00:00 22/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [10:00:00 22/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [10:00:00 22/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [10:00:00 22/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: Nasal Cannula st: NotStopd t0: [10:00:00 22/12/2015] id: O2 Flow (lpm) el: 0 cu: CCU cg: RN v1: 3 u1: lpm st: NotStopd t0: [10:00:00 22/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [10:00:00 22/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [10:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [10:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 46 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [10:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 97 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [10:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [10:00:00 22/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [10:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [10:00:00 22/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Normal st: NotStopd t0: [10:00:00 22/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [10:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 9 u1: BPM st: NotStopd t0: [10:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 92 u1: % st: NotStopd t0: [10:00:00 22/12/2015] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: Tan v2: Thick st: NotStopd t0: [10:00:00 22/12/2015] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Expectorated v2: Moderate st: NotStopd t0: [10:00:00 22/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 22/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [10:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 22/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [08:00:00 22/12/2015] id: GT Flush PO/Gastric el: 1 cu: CCU cg: RN ai: 304 vo: 150 vu: ml t0: [09:00:00 22/12/2015] id: GT Flush PO/Gastric el: 1 cu: CCU cg: RN ai: 304 vo: 100 vu: ml t0: [10:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [10:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [10:00:00 22/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 4.95 vu: ml st: Stopped t0: [10:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 30 vu: ml t0: [10:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 65 vu: ml
t0: [10:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [10:00:00 22/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped
tf: [10:00:00 23/12/2015] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Furosemide v1: 20 u1: mg
t0: [11:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [11:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [11:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 109 u1: BPM st: NotStopd t0: [11:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [11:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 42 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [11:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 102 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [11:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [11:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [11:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [11:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 14 u1: BPM st: NotStopd t0: [11:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [11:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [11:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [11:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [11:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 38 vu: ml
t0: [11:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [12:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [12:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 112 u1: BPM st: NotStopd t0: [12:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [12:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 42 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [12:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 108 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [12:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [12:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [12:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [12:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 18 u1: BPM st: NotStopd t0: [12:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [12:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [12:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml
t0: [12:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 22/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Family Called st: NotStopd t0: [11:00:00 22/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 22/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Calm st: NotStopd t0: [13:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [13:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [13:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 22/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Family Called st: NotStopd t0: [13:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 116 u1: BPM st: NotStopd t0: [13:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [13:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 45 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [13:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 113 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [13:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [13:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [13:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [13:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 17 u1: BPM st: NotStopd t0: [13:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [13:00:00 22/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Relative st: NotStopd t0: [13:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 22/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Calm st: NotStopd t0: [14:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [14:00:00 22/12/2015] id: Chest PT R/L el: 0 cu: CCU cg: RN v1: Done v2: Done st: NotStopd t0: [14:00:00 22/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 22/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Weak st: NotStopd t0: [14:00:00 22/12/2015] id: Cough Type el: 0 cu: CCU cg: RN v1: Productive st: NotStopd t0: [14:00:00 22/12/2015] id: Cough/Deep Breathe el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 22/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Renal st: NotStopd t0: [14:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 22/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [14:00:00 22/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 22/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [14:00:00 22/12/2015] id: GI Intub #1/Site el: 0 cu: CCU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [14:00:00 22/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [14:00:00 22/12/2015] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 22/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [14:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 110 u1: BPM st: NotStopd t0: [14:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 22/12/2015] id: Height of Bed el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v2: ? st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#2 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#3 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [14:00:00 22/12/2015] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [14:00:00 22/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [14:00:00 22/12/2015] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 22/12/2015] id: INV#3 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 22/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 22/12/2015] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 22/12/2015] id: KneeImmobilizer/Loc el: 0 cu: CCU cg: RN v1: Off st: NotStopd t0: [14:00:00 22/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 22/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [14:00:00 22/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Dozing Intermit st: NotStopd t0: [14:00:00 22/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [14:00:00 22/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 22/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [14:00:00 22/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 22/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [14:00:00 22/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [14:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 31 u1: mmHg st: NotStopd t0: [14:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 48 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [14:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 116 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [14:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [14:00:00 22/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [14:00:00 22/12/2015] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [14:00:00 22/12/2015] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:00:00 22/12/2015] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [14:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [14:00:00 22/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [14:00:00 22/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [14:00:00 22/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Normal st: NotStopd t0: [14:00:00 22/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [14:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 34 u1: BPM st: NotStopd t0: [14:00:00 22/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 22/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 22/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [14:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [14:00:00 22/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 22/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [14:00:00 22/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.8889 u1: Deg. C st: NotStopd t0: [14:00:00 22/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 96.6 u1: Deg. F st: NotStopd t0: [14:00:00 22/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [14:00:00 22/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 22/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 22/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [14:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 22/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Calm st: NotStopd t0: [14:00:00 22/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [14:00:00 22/12/2015] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [14:00:00 22/12/2015] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 22/12/2015] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 22/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 22/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [13:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [13:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [13:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [14:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [14:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [14:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [14:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 230 vu: ml
t0: [13:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [14:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [15:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [15:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [15:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 113 u1: BPM st: NotStopd t0: [15:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 31 u1: mmHg st: NotStopd t0: [15:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 46 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [15:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 114 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [15:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [15:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [15:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [15:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 34 u1: BPM st: NotStopd t0: [15:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [15:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [15:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [15:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml
t0: [15:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:21:00 22/12/2015] id: Blood Products Hematology el: 0 cu: CCU cg: 140 v1: Y rs: Final st: NotStopd
t0: [12:00:00 22/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 22/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [12:00:00 22/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [16:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 22/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [16:00:00 22/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 121 u1: BPM st: NotStopd t0: [16:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 35 u1: mmHg st: NotStopd t0: [16:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 48 u1: mmHg v2: 27 u2: mmHg st: NotStopd t0: [16:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 122 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [16:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [16:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [16:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [16:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd t0: [16:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [17:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 22/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [17:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 118 u1: BPM st: NotStopd t0: [17:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [17:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 46 u1: mmHg v2: 26 u2: mmHg st: NotStopd t0: [17:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 119 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [17:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [17:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [17:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 28 u1: BPM st: NotStopd t0: [17:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 53 u1: % st: NotStopd t0: [17:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 22/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 60 vu: ml t0: [16:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [16:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [16:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [17:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [17:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [17:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [17:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 140 vu: ml
t0: [16:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [17:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [18:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [18:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 122 u1: BPM st: NotStopd t0: [18:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 32 u1: mmHg st: NotStopd t0: [18:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 45 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [18:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 118 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [18:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [18:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [18:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 22 u1: BPM st: NotStopd t0: [18:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [18:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [18:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [18:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml
t0: [18:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [15:00:00 22/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Fam Talked to MD st: NotStopd t0: [17:00:00 22/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Fam Talked to MD st: NotStopd t0: [17:00:00 22/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 22/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Fam Talked to MD st: NotStopd
t0: [19:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [19:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [19:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 121 u1: BPM st: NotStopd t0: [19:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [19:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 42 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [19:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 117 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [19:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [19:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [19:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [19:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 28 u1: BPM st: NotStopd t0: [19:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 92 u1: % st: NotStopd t0: [19:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [19:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [19:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [19:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 60 vu: ml
t0: [19:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [14:00:00 16/01/2016] pt: Unit Dose rt: IV fr: Q4H:PRN m1: Lorazepam v1: 1 u1: mg tf: [14:00:00 16/01/2016] pt: Unit Dose rt: PO fr: Q4H:PRN m1: Lorazepam v1: 1 u1: mg
t0: [20:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [20:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 22/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [20:00:00 22/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 121 u1: BPM st: NotStopd t0: [20:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 22/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: Nasal Cannula st: NotStopd t0: [20:00:00 22/12/2015] id: O2 Flow (lpm) el: 0 cu: CCU cg: RN v1: 3 u1: lpm st: NotStopd t0: [20:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [20:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 46 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [20:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 116 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [20:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [20:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [20:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 29 u1: BPM st: NotStopd t0: [20:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [20:00:00 22/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [20:00:00 22/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.1667 u1: Deg. C st: NotStopd t0: [20:00:00 22/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.1 u1: Deg. F st: NotStopd t0: [20:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 22/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [20:00:00 22/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd
t0: [20:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [20:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [20:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml
t0: [20:00:00 22/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 22/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Weak st: NotStopd t0: [20:00:00 22/12/2015] id: Cough Type el: 0 cu: CCU cg: RN v1: Productive st: NotStopd t0: [20:00:00 22/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: Renal st: NotStopd t0: [20:00:00 22/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 22/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 22/12/2015] id: GI Intub #1/Site el: 0 cu: CCU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 22/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 22/12/2015] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 22/12/2015] id: Height of Bed el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [20:00:00 22/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 22/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 22/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [20:00:00 22/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [20:00:00 22/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [20:00:00 22/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 22/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [20:00:00 22/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 22/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 22/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [20:00:00 22/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [20:00:00 22/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [20:00:00 22/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [20:00:00 22/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Dyspneic st: NotStopd t0: [20:00:00 22/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 22/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 22/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 22/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 22/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [20:00:00 22/12/2015] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [20:00:00 22/12/2015] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 22/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 22/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [20:00:00 22/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [20:00:00 22/12/2015] id: Family Communication el: 0 cu: CCU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 22/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 22/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 22/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [20:00:00 22/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 22/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Anxious st: NotStopd t0: [20:00:00 22/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 22/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 22/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 22/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 22/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 22/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 13 u1: number st: NotStopd t0: [20:00:00 22/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Sl. Limited st: NotStopd
t0: [18:00:00 22/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd t0: [20:00:00 22/12/2015] id: Chest PT R/L el: 0 cu: CCU cg: RN v1: Done v2: Done st: NotStopd t0: [20:00:00 22/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v2: ? st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#2 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#3 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [20:00:00 22/12/2015] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 22/12/2015] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 22/12/2015] id: INV#3 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 22/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 22/12/2015] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 22/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd
t0: [21:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [21:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 122 u1: BPM st: NotStopd t0: [21:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 33 u1: mmHg st: NotStopd t0: [21:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 50 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [21:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 122 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [21:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [21:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [21:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [21:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 34 u1: BPM st: NotStopd t0: [21:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [21:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [21:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [21:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [21:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [21:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 90 vu: ml
t0: [22:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [22:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 124 u1: BPM st: NotStopd t0: [22:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [22:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 50 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [22:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 129 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [22:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [22:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [22:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 28 u1: BPM st: NotStopd t0: [22:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [22:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [22:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [22:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml
t0: [22:00:00 22/12/2015] id: Po Intake PO/Gastric el: 1 cu: CCU cg: RN ai: 103 vo: 150 vu: ml
t0: [22:45:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 163 u1: BPM st: NotStopd t0: [22:45:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Atrial Fib st: NotStopd t0: [22:45:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 119 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [22:45:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [22:45:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [22:45:00 22/12/2015] id: Procedures el: 0 cu: CCU cg: RN v1: EKG st: NotStopd t0: [22:45:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [22:45:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
tf: [13:00:00 23/12/2015] pt: Unit Dose rt: IV fr: ONCE fs: 23 dn: 1 m1: Furosemide v1: 40 u1: mg
t0: [22:55:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [22:55:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:55:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:55:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:55:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:55:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 154 u1: BPM st: NotStopd t0: [22:55:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Atrial Fib st: NotStopd t0: [22:55:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 32 u1: mmHg st: NotStopd t0: [22:55:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 46 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [22:55:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 121 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [22:55:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [22:55:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:55:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [22:55:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 2 u1: BPM st: NotStopd t0: [22:55:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [22:55:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 22/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [23:00:00 22/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 22/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [23:00:00 22/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 22/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 22/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 118 u1: BPM st: NotStopd t0: [23:00:00 22/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Atrial Fib st: NotStopd t0: [23:00:00 22/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [23:00:00 22/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 40 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [23:00:00 22/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 101 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [23:00:00 22/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [23:00:00 22/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [23:00:00 22/12/2015] id: Previous Weight el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [23:00:00 22/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [23:00:00 22/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [23:00:00 22/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:55:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [23:00:00 22/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 22/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [23:00:00 22/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [23:00:00 22/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [23:00:00 22/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 70 vu: ml
t0: [23:00:00 22/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 36 u1: BPM st: NotStopd
id: Neosynephrine-k el: 100 cu: CCU cg: RN io: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions am: 60 du: mcgkgmin rt: IV Drip
id: D5W el: 1 cu: CCU cg: RN io: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [00:00:00 23/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [00:00:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [00:00:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 140 u1: BPM st: NotStopd t0: [00:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Atrial Fib st: NotStopd t0: [00:00:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [00:00:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 40 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [00:00:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 99 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [00:00:00 23/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [00:00:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [00:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 39 u1: BPM st: NotStopd t0: [00:00:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 22/12/2015] id: O2 Flow (lpm) el: 0 cu: CCU cg: RN v1: 4 u1: lpm st: NotStopd t0: [00:00:00 23/12/2015] id: O2 Delivery Device el: 0 cu: CCU cg: RN v1: Nasal Cannula st: NotStopd t0: [00:00:00 23/12/2015] id: O2 Flow (lpm) el: 0 cu: CCU cg: RN v1: 4 u1: lpm st: NotStopd
t0: [00:00:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 250 vu: ml t0: [00:00:00 23/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [00:00:00 23/12/2015] id: Nepro Tube Feeding el: 1 cu: CCU cg: RN ai: 155 vo: 40 vu: ml t0: [00:00:00 23/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 30 vu: ml
t0: [23:00:00 23/12/2015] dt: 24 id: Tube Feeds In Total el: 1 cu: CCU cg: RN cv: 40 ap: none
t0: [00:00:00 23/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 23/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Weak st: NotStopd t0: [00:00:00 23/12/2015] id: Cough Type el: 0 cu: CCU cg: RN v1: Productive st: NotStopd t0: [00:00:00 23/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [00:00:00 23/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [00:00:00 23/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 23/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [00:00:00 23/12/2015] id: GI Intub #1/Site el: 0 cu: CCU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 23/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 23/12/2015] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 23/12/2015] id: Height of Bed el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [00:00:00 23/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 23/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 23/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [00:00:00 23/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Alert st: NotStopd t0: [00:00:00 23/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [00:00:00 23/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 23/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [00:00:00 23/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 23/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Oriented x 3 st: NotStopd t0: [00:00:00 23/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [00:00:00 23/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [00:00:00 23/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [00:00:00 23/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [00:00:00 23/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Dyspneic st: NotStopd t0: [00:00:00 23/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 23/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 23/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 23/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [00:00:00 23/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 23/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 23/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 23/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [00:00:00 23/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Anxious st: NotStopd t0: [00:00:00 23/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [00:00:00 23/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 23/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 23/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 23/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 23/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 23/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 13 u1: number st: NotStopd t0: [00:00:00 23/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 23/12/2015] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [00:00:00 23/12/2015] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 23/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 23/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [22:00:00 22/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd t0: [00:00:00 23/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [00:00:00 23/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 23/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v2: ? st: NotStopd t0: [00:00:00 23/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 23/12/2015] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [00:00:00 23/12/2015] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [00:00:00 23/12/2015] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 23/12/2015] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [00:00:00 23/12/2015] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [00:00:00 23/12/2015] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 23/12/2015] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 23/12/2015] id: INV#3 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 23/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 23/12/2015] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd
t0: [00:05:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 129 u1: BPM st: NotStopd t0: [00:05:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 83 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [00:05:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [00:05:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [00:05:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:10:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 118 u1: BPM st: NotStopd t0: [00:10:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 80 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [00:10:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 56 u1: mmHg st: NotStopd t0: [00:10:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [00:10:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:15:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 116 u1: BPM st: NotStopd t0: [00:15:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 81 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [00:15:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 57 u1: mmHg st: NotStopd t0: [00:15:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [00:15:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 23/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [00:00:00 23/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [00:00:00 23/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.2 u1: Deg. F st: NotStopd
t0: [00:30:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [00:30:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:30:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:30:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:30:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 136 u1: BPM st: NotStopd t0: [00:30:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Atrial Fib st: NotStopd t0: [00:30:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [00:30:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 44 u1: mmHg v2: 19 u2: mmHg st: NotStopd t0: [00:30:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 81 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [00:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [00:30:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [00:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 36 u1: BPM st: NotStopd t0: [00:30:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [00:30:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:30:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [00:30:00 23/12/2015] tf: [00:55:00 23/12/2015] dt: 25 id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 5.0101 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [00:50:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [00:50:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:50:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:50:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 133 u1: BPM st: NotStopd t0: [00:50:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [00:50:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 37 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [00:50:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 72 u1: mmHg v2: 43 u2: mmHg st: NotStopd t0: [00:50:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 52 u1: mmHg st: NotStopd t0: [00:50:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:50:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [00:50:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 7 u1: BPM st: NotStopd t0: [00:50:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [00:50:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:55:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [00:55:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:55:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:55:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 140 u1: BPM st: NotStopd t0: [00:55:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [00:55:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 39 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [00:55:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 78 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [00:55:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 56 u1: mmHg st: NotStopd t0: [00:55:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:55:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [00:55:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [00:55:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [00:55:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:55:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 0 vu: ml nb: 1
t0: [00:50:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [00:50:00 23/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 7 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:55:00 23/12/2015] tf: [10:28:00 23/12/2015] dt: 573 id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:55:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [00:55:00 23/12/2015] id: Dopamine el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 7 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped
id: Propofol el: 100 cu: CCU cg: RN io: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions am: 500 du: mcgkgmin rt: IV Drip
tf: [13:00:00 23/12/2015] pt: Unit Dose rt: IV fr: ONCE MR1 fs: 1 dn: 1 m1: Metoprolol v1: 5 u1: mg
id: N/A el: 1 cu: CCU cg: RN io: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions vo: 50 du: vl rt: Intravenous Push
t0: [01:00:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [01:00:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 140 u1: BPM st: NotStopd t0: [01:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Atrial Fib st: NotStopd t0: [01:00:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [01:00:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 38 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [01:00:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 80 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [01:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [01:00:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [01:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 28 u1: BPM st: NotStopd t0: [01:00:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [01:00:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [01:05:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 90 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [01:05:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 70 u1: mmHg st: NotStopd
t0: [00:30:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 250 vu: ml
t0: [01:15:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [01:15:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:15:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:15:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:15:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 132 u1: BPM st: NotStopd t0: [01:15:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Atrial Fib st: NotStopd t0: [01:15:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 37 u1: mmHg st: NotStopd t0: [01:15:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 51 u1: mmHg v2: 26 u2: mmHg st: NotStopd t0: [01:15:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 116 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [01:15:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [01:15:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:15:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [01:15:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 38 u1: BPM st: NotStopd t0: [01:15:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [01:15:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:15:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:15:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [01:15:00 23/12/2015] id: Significant Events el: 0 cu: CCU cg: RN v1: Intubated st: NotStopd t0: [01:20:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [01:20:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:20:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:20:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:20:00 23/12/2015] id: FiO2 Set el: 0 cu: CCU cg: RN v1: 1 u1: torr st: NotStopd t0: [01:20:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 130 u1: BPM st: NotStopd t0: [01:20:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Atrial Fib st: NotStopd t0: [01:20:00 23/12/2015] id: Airway Size el: 0 cu: CCU cg: RN v1: 7.5 mm st: NotStopd t0: [01:20:00 23/12/2015] id: Airway Type el: 0 cu: CCU cg: RN v1: Endotracheal st: NotStopd t0: [01:20:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [01:20:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 48 u1: mmHg v2: 27 u2: mmHg st: NotStopd t0: [01:20:00 23/12/2015] id: PEEP Set el: 0 cu: CCU cg: RN v1: 5 u1: cmH2O st: NotStopd t0: [01:20:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 103 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [01:20:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [01:20:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:20:00 23/12/2015] id: Pressure Support el: 0 cu: CCU cg: RN v1: 5 u1: . st: NotStopd t0: [01:20:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [01:20:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 15 u1: BPM st: NotStopd t0: [01:20:00 23/12/2015] id: Respiratory Rate Set el: 0 cu: CCU cg: RN v1: 18 u1: BPM st: NotStopd t0: [01:20:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [01:20:00 23/12/2015] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [01:20:00 23/12/2015] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [01:20:00 23/12/2015] id: Tidal Volume (Set) el: 0 cu: CCU cg: RN v1: 500 u1: ml/B st: NotStopd t0: [01:20:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:25:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [01:25:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:25:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:25:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:25:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 129 u1: BPM st: NotStopd t0: [01:25:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Atrial Fib st: NotStopd t0: [01:25:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 46 u1: mmHg st: NotStopd t0: [01:25:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 60 u1: mmHg v2: 39 u2: mmHg st: NotStopd t0: [01:25:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 113 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [01:25:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [01:25:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:25:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [01:25:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 15 u1: BPM st: NotStopd t0: [01:25:00 23/12/2015] id: Significant Events el: 0 cu: CCU cg: RN st: NotStopd t0: [01:25:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [01:25:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:30:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [01:30:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:30:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:30:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 113 u1: BPM st: NotStopd t0: [01:30:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:30:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 39 u1: mmHg st: NotStopd t0: [01:30:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 51 u1: mmHg v2: 33 u2: mmHg st: NotStopd t0: [01:30:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 110 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [01:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [01:30:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [01:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 9 u1: BPM st: NotStopd t0: [01:30:00 23/12/2015] id: Significant Events el: 0 cu: CCU cg: RN v1: Cardioversion st: NotStopd t0: [01:30:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [01:30:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:20:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:20:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [01:25:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:25:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [01:30:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:30:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [01:20:00 23/12/2015] id: Compliance (40-60ml) el: 0 cu: CCU cg: RRT v1: 15.625 u1: ml/cmH st: NotStopd t0: [01:20:00 23/12/2015] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [01:20:00 23/12/2015] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [01:20:00 23/12/2015] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:2.3 st: NotStopd t0: [01:20:00 23/12/2015] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT u1: Deg. C st: NotStopd t0: [01:20:00 23/12/2015] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 24 st: NotStopd t0: [01:20:00 23/12/2015] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 4 st: NotStopd t0: [01:20:00 23/12/2015] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [01:20:00 23/12/2015] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 7.89 u1: L/min st: NotStopd t0: [01:20:00 23/12/2015] id: Peak Flow el: 0 cu: CCU cg: RRT u1: L/m st: NotStopd t0: [01:20:00 23/12/2015] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [01:20:00 23/12/2015] id: Plateau Pressure el: 0 cu: CCU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [01:20:00 23/12/2015] id: Plateau-Off el: 0 cu: CCU cg: RRT v1: Yes st: NotStopd t0: [01:20:00 23/12/2015] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [01:20:00 23/12/2015] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [01:20:00 23/12/2015] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [01:20:00 23/12/2015] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 512 u1: ml/B st: NotStopd t0: [01:20:00 23/12/2015] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: SIMV+PS st: NotStopd t0: [01:20:00 23/12/2015] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [01:20:00 23/12/2015] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [01:35:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [01:35:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:35:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:35:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 103 u1: BPM st: NotStopd t0: [01:35:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [01:35:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 36 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [01:35:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 80 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [01:35:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [01:35:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:35:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [01:35:00 23/12/2015] id: Procedures el: 0 cu: CCU cg: RN v1: EKG st: NotStopd t0: [01:35:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 16 u1: BPM st: NotStopd t0: [01:35:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [01:35:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:35:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CCU cg: RN ai: 109 vo: 0 vu: ml nb: 1
t0: [01:35:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:35:00 23/12/2015] tf: [10:28:00 23/12/2015] dt: 533 id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 5 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [01:35:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:00:00 23/12/2015] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.5 u1: torr st: NotStopd
t0: [02:00:00 23/12/2015] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [02:00:00 23/12/2015] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: Copious st: NotStopd
t0: [02:00:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [02:00:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [02:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 102 u1: BPM st: NotStopd t0: [02:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 93 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [02:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [02:00:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [02:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [02:00:00 23/12/2015] id: Procedures el: 0 cu: CCU cg: RN v1: Sputum Cx st: NotStopd t0: [02:00:00 23/12/2015] id: Radiologic Study el: 0 cu: CCU cg: RN v1: Chest Xray st: NotStopd t0: [02:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 20 u1: BPM st: NotStopd t0: [02:00:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [01:00:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 2.5 vu: ml t0: [01:00:00 23/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [01:00:00 23/12/2015] tf: [10:28:00 23/12/2015] dt: 568 id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 1.375 vu: ml t0: [02:00:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [02:00:00 23/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [02:00:00 23/12/2015] tf: [10:28:00 23/12/2015] dt: 508 id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CCU cg: RN ai: 109 vo: 0.825 vu: ml t0: [02:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 16.5 vu: ml
t0: [01:00:00 23/12/2015] tf: [10:28:00 23/12/2015] dt: 568 id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CCU cg: RN ai: 189 vo: 6 vu: ml
t0: [02:00:00 23/12/2015] tf: [10:28:00 23/12/2015] dt: 508 id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 0 vu: ml t0: [02:00:00 23/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 20 vu: ml
t0: [23:00:00 23/12/2015] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN cv: 0 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN cv: 105 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN cv: 105 ap: none
t0: [02:00:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 26 u1: mmHg st: NotStopd t0: [02:00:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 34 u1: mmHg v2: 22 u2: mmHg st: NotStopd
t0: [02:10:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 83 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [02:10:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 64 u1: mmHg st: NotStopd
t0: [02:10:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.50303 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [02:34:00 23/12/2015] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.49 rs: Final st: NotStopd t0: [02:34:00 23/12/2015] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 4 rs: Final st: NotStopd t0: [02:34:00 23/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 27 rs: Final st: NotStopd t0: [02:34:00 23/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 35 u1: mmHg rs: Final st: NotStopd t0: [02:34:00 23/12/2015] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 160 u1: mmHg rs: Final st: NotStopd t0: [02:34:00 23/12/2015] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.49 rs: Final st: NotStopd
t0: [02:34:00 23/12/2015] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 99 u1: % rs: Final st: NotStopd
t0: [02:00:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 10.101 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [02:30:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [02:30:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [02:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [02:30:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:30:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:30:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 96 u1: BPM st: NotStopd t0: [02:30:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [02:30:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 26 u1: mmHg st: NotStopd t0: [02:30:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 33 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [02:30:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 98 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [02:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [02:30:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [02:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [02:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 18 u1: BPM st: NotStopd t0: [02:30:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [02:30:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:30:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.50303 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:30:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 15.1515 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [02:30:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:30:00 23/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 10.3 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 10.3 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 24.1 u1: % rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 7.2 u1: gm/dl rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 576 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 2.65 u1: /mic l rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 10.3 rs: Final st: NotStopd
t0: [03:00:00 23/12/2015] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [03:00:00 23/12/2015] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [03:00:00 23/12/2015] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [03:00:00 23/12/2015] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 24 st: NotStopd t0: [03:00:00 23/12/2015] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [03:00:00 23/12/2015] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd
t0: [02:30:00 23/12/2015] id: PT el: 0 cu: CCU cg: 140 v1: 14.6 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: INR Coags el: 0 cu: CCU cg: 140 v1: 1.4 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: PTT Coags el: 0 cu: CCU cg: 140 v1: 65.5 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CCU cg: 140 v1: 1.4 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: PT(11-13.5) Coags el: 0 cu: CCU cg: 140 v1: 14.6 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: PTT(22-35) Coags el: 0 cu: CCU cg: 140 v1: 65.5 rs: Final st: NotStopd
t0: [02:34:00 23/12/2015] id: CaO2 el: 0 cu: CCU cg: RN v1: 10.0475 u1: ml/dl st: NotStopd t0: [02:34:00 23/12/2015] id: Cardiac Index el: 0 cu: CCU cg: RN v1: 2.39766 u1: ... st: NotStopd t0: [02:34:00 23/12/2015] id: DO2I el: 0 cu: CCU cg: RN v1: 240 u1: ml/m/m st: NotStopd t0: [02:34:00 23/12/2015] id: Hemoglobin Hematology el: 0 cu: CCU cg: RN v1: 7.2 u1: gm/dl rs: Manual st: NotStopd t0: [02:34:00 23/12/2015] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CCU cg: RN v1: 45 rs: Manual st: NotStopd t0: [02:34:00 23/12/2015] id: C.O. (fick) el: 0 cu: CCU cg: RN v1: 4.10275 u1: L/min st: NotStopd
tf: [16:00:00 31/12/2015] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Phenylephrine HCl v1: 60 u1: mg m2: D5W v2: 250 u2: ml tf: [16:00:00 31/12/2015] pt: Unit Dose rt: IV DRIP fr: TITRATE TO m1: Propofol (Generic) v1: 1000 u1: mg tf: [21:00:00 26/02/2016] pt: Unit Dose rt: IH fr: Q4-6H:PRN m1: Ipratropium Bromide MDI v1: 6 u1: PUFF tf: [21:00:00 26/02/2016] pt: Unit Dose rt: IH fr: Q6H:PRN m1: Albuterol Inhaler v1: 6 u1: PUFF
t0: [03:00:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [03:00:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [03:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 91 u1: BPM st: NotStopd t0: [03:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 26 u1: mmHg st: NotStopd t0: [03:00:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 33 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [03:00:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 85 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [03:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [03:00:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [03:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [03:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 16 u1: BPM st: NotStopd t0: [03:00:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 500 vu: ml t0: [03:00:00 23/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 11 vu: ml t0: [03:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CCU cg: RN ai: 109 vo: 5 vu: ml t0: [03:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 23.4167 vu: ml
t0: [03:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.50303 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 15.1515 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:00:00 23/12/2015] id: Heparin el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [03:00:00 23/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd
t0: [03:00:00 23/12/2015] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [03:00:00 23/12/2015] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: Moderate st: NotStopd
tf: [13:00:00 23/12/2015] pt: Unit Dose rt: PO fr: ONCE fs: 4 dn: 1 m1: Amiodarone HCl v1: 600 u1: mg tf: [13:00:00 23/12/2015] pt: Unit Dose rt: PO fr: ONCE fs: 4 dn: 1 m1: Amiodarone HCl v1: 600 u1: mg
t0: [02:30:00 23/12/2015] id: BUN el: 0 cu: CCU cg: 140 v1: 63 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 7.6 u1: mg/dl rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 101 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 1.6 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 109 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 1.9 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 3.8 u1: mEq/L rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 5 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 134 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 63 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 7.6 u1: mg/dl rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 25 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 101 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 1.6 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 109 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 1.9 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 3.8 u1: mEq/L rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 5 rs: Final st: NotStopd t0: [02:30:00 23/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 134 rs: Final st: NotStopd
t0: [03:00:00 23/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 10 vu: ml t0: [04:00:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 500 vu: ml t0: [04:00:00 23/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CCU cg: RN ai: 190 vo: 0 vu: ml t0: [04:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CCU cg: RN ai: 109 vo: 6 vu: ml t0: [04:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 24.8 vu: ml t0: [04:00:00 23/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 10 vu: ml
t0: [04:00:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [04:00:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 88 u1: BPM st: NotStopd t0: [04:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [04:00:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 34 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [04:00:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 89 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [04:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [04:00:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [04:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 14 u1: BPM st: NotStopd t0: [04:00:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.50303 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 15.1515 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [04:00:00 23/12/2015] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [04:00:00 23/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 23/12/2015] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd
t0: [04:00:00 23/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 23/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Weak st: NotStopd t0: [04:00:00 23/12/2015] id: Cough Type el: 0 cu: CCU cg: RN v1: Productive st: NotStopd t0: [04:00:00 23/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [04:00:00 23/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 23/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 15 u1: points st: NotStopd t0: [04:00:00 23/12/2015] id: GI Intub #1/Site el: 0 cu: CCU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 23/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 23/12/2015] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 23/12/2015] id: Height of Bed el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 23/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 23/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 23/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [04:00:00 23/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 23/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [04:00:00 23/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 23/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [04:00:00 23/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 23/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 23/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [04:00:00 23/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [04:00:00 23/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [04:00:00 23/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [04:00:00 23/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Normal st: NotStopd t0: [04:00:00 23/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [04:00:00 23/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 23/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 23/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 5 Oriented st: NotStopd t0: [04:00:00 23/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [04:00:00 23/12/2015] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [04:00:00 23/12/2015] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 23/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 23/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [04:00:00 23/12/2015] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: Both Legs v2: 6 mm st: NotStopd t0: [04:00:00 23/12/2015] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 23/12/2015] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 23/12/2015] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [04:00:00 23/12/2015] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 23/12/2015] id: Behavior el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 23/12/2015] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 23/12/2015] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 23/12/2015] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 23/12/2015] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 23/12/2015] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 23/12/2015] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [04:00:00 23/12/2015] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd
t0: [04:00:00 23/12/2015] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 23/12/2015] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 23/12/2015] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v2: ? st: NotStopd t0: [04:00:00 23/12/2015] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 23/12/2015] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [04:00:00 23/12/2015] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [04:00:00 23/12/2015] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 23/12/2015] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [04:00:00 23/12/2015] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 12 v2: 22 st: NotStopd t0: [04:00:00 23/12/2015] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 23/12/2015] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 23/12/2015] id: INV#3 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 23/12/2015] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 23/12/2015] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd
t0: [04:00:00 23/12/2015] id: Compliance (40-60ml) el: 0 cu: CCU cg: RRT v1: 16.129 u1: ml/cmH st: NotStopd t0: [04:00:00 23/12/2015] id: RSBI Not Completed el: 0 cu: CCU cg: RRT v1: Other/Remarks st: NotStopd t0: [04:00:00 23/12/2015] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [04:00:00 23/12/2015] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [04:00:00 23/12/2015] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:00:00 23/12/2015] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 23/12/2015] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3.3 st: NotStopd t0: [04:00:00 23/12/2015] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 23/12/2015] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 23/12/2015] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT u1: Deg. C st: NotStopd t0: [04:00:00 23/12/2015] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 24 st: NotStopd t0: [04:00:00 23/12/2015] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 23/12/2015] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [04:00:00 23/12/2015] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 6.7 u1: L/min st: NotStopd t0: [04:00:00 23/12/2015] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 23/12/2015] id: Peak Flow el: 0 cu: CCU cg: RRT u1: L/m st: NotStopd t0: [04:00:00 23/12/2015] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [04:00:00 23/12/2015] id: Plateau Pressure el: 0 cu: CCU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [04:00:00 23/12/2015] id: Plateau-Off el: 0 cu: CCU cg: RRT v1: Yes st: NotStopd t0: [04:00:00 23/12/2015] id: Pressure Support el: 0 cu: CCU cg: RRT v1: 5 u1: . st: NotStopd t0: [04:00:00 23/12/2015] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 23/12/2015] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [04:00:00 23/12/2015] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [04:00:00 23/12/2015] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:00:00 23/12/2015] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [04:00:00 23/12/2015] id: Tidal Volume (Set) el: 0 cu: CCU cg: RRT v1: 500 u1: ml/B st: NotStopd t0: [04:00:00 23/12/2015] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: SIMV+PS st: NotStopd t0: [04:00:00 23/12/2015] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 23/12/2015] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [03:00:00 23/12/2015] id: Procedures el: 0 cu: CCU cg: RN v1: Cardiac Echo st: NotStopd t0: [04:00:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN u1: % st: NotStopd t0: [05:00:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [05:00:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 90 u1: BPM st: NotStopd t0: [05:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [05:00:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 35 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [05:00:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 92 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [05:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [05:00:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [05:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 14 u1: BPM st: NotStopd t0: [05:00:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 15.1515 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [05:00:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [05:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CCU cg: RN ai: 109 vo: 6 vu: ml t0: [05:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 24.8 vu: ml
t0: [04:00:00 23/12/2015] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [04:00:00 23/12/2015] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [04:00:00 23/12/2015] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.2 u1: Deg. F st: NotStopd
t0: [06:00:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [06:00:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [06:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 95 u1: BPM st: NotStopd t0: [06:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 32 u1: mmHg st: NotStopd t0: [06:00:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 41 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [06:00:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 96 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [06:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [06:00:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [06:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [06:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 15 u1: BPM st: NotStopd t0: [06:00:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 67 u1: % st: NotStopd t0: [06:00:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 23/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 15 vu: ml t0: [06:00:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 5 vu: ml t0: [06:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CCU cg: RN ai: 109 vo: 6 vu: ml t0: [06:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 23.1 vu: ml t0: [06:00:00 23/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 15 vu: ml
t0: [06:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 20.202 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [06:00:00 23/12/2015] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [06:00:00 23/12/2015] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [06:00:00 23/12/2015] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd
t0: [06:15:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 76 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [06:15:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 58 u1: mmHg st: NotStopd
t0: [06:15:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 500 vu: ml
t0: [06:28:00 23/12/2015] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.48 rs: Final st: NotStopd t0: [06:28:00 23/12/2015] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 4 rs: Final st: NotStopd t0: [06:28:00 23/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 28 rs: Final st: NotStopd t0: [06:28:00 23/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 36 u1: mmHg rs: Final st: NotStopd t0: [06:28:00 23/12/2015] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 211 u1: mmHg rs: Final st: NotStopd t0: [06:28:00 23/12/2015] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.48 rs: Final st: NotStopd
t0: [06:00:00 23/12/2015] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [06:00:00 23/12/2015] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [06:00:00 23/12/2015] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [06:00:00 23/12/2015] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [06:00:00 23/12/2015] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 24 st: NotStopd t0: [06:00:00 23/12/2015] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 12 u1: BPM st: NotStopd t0: [06:00:00 23/12/2015] id: Tidal Volume (Set) el: 0 cu: CCU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [06:00:00 23/12/2015] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd
t0: [07:00:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [07:00:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [07:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 89 u1: BPM st: NotStopd t0: [07:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [07:00:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 39 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [07:00:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 78 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [07:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [07:00:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [07:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [07:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 12 u1: BPM st: NotStopd t0: [07:00:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 20.202 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [07:00:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 500 vu: ml t0: [07:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CCU cg: RN ai: 109 vo: 8 vu: ml t0: [07:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 23.1 vu: ml
t0: [07:00:00 23/12/2015] id: Compliance (40-60ml) el: 0 cu: CCU cg: RRT v1: 17.3077 u1: ml/cmH st: NotStopd t0: [07:00:00 23/12/2015] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [07:00:00 23/12/2015] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [07:00:00 23/12/2015] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [07:00:00 23/12/2015] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [07:00:00 23/12/2015] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3.3 st: NotStopd t0: [07:00:00 23/12/2015] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [07:00:00 23/12/2015] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [07:00:00 23/12/2015] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT u1: Deg. C st: NotStopd t0: [07:00:00 23/12/2015] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 24 st: NotStopd t0: [07:00:00 23/12/2015] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 4 st: NotStopd t0: [07:00:00 23/12/2015] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [07:00:00 23/12/2015] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 5.1 u1: L/min st: NotStopd t0: [07:00:00 23/12/2015] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:00:00 23/12/2015] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [07:00:00 23/12/2015] id: Plateau Pressure el: 0 cu: CCU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [07:00:00 23/12/2015] id: Plateau-Off el: 0 cu: CCU cg: RRT v1: Yes st: NotStopd t0: [07:00:00 23/12/2015] id: Pressure Support el: 0 cu: CCU cg: RRT v1: 5 u1: . st: NotStopd t0: [07:00:00 23/12/2015] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [07:00:00 23/12/2015] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 12 u1: BPM st: NotStopd t0: [07:00:00 23/12/2015] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 12 u1: BPM st: NotStopd t0: [07:00:00 23/12/2015] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [07:00:00 23/12/2015] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [07:00:00 23/12/2015] id: Tidal Volume (Set) el: 0 cu: CCU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [07:00:00 23/12/2015] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: SIMV+PS st: NotStopd t0: [07:00:00 23/12/2015] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [07:00:00 23/12/2015] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [07:45:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [07:45:00 23/12/2015] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [07:45:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [07:45:00 23/12/2015] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [07:45:00 23/12/2015] id: Cough Effort el: 0 cu: CCU cg: RN v1: Weak st: NotStopd t0: [07:45:00 23/12/2015] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [07:45:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [07:45:00 23/12/2015] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [07:45:00 23/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [07:45:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:45:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:45:00 23/12/2015] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [07:45:00 23/12/2015] id: GCS Total el: 0 cu: CCU cg: RN v1: 7 u1: points st: NotStopd t0: [07:45:00 23/12/2015] id: GI Intub #1/Site el: 0 cu: CCU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [07:45:00 23/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [07:45:00 23/12/2015] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [07:45:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 88 u1: BPM st: NotStopd t0: [07:45:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [07:45:00 23/12/2015] id: Height of Bed el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [07:45:00 23/12/2015] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft st: NotStopd t0: [07:45:00 23/12/2015] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [07:45:00 23/12/2015] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [07:45:00 23/12/2015] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [07:45:00 23/12/2015] id: Angio Appearance #1 el: 0 cu: CCU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [07:45:00 23/12/2015] id: Motor Response el: 0 cu: CCU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [07:45:00 23/12/2015] id: Angio Dressing #1 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [07:45:00 23/12/2015] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [07:45:00 23/12/2015] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [07:45:00 23/12/2015] id: Angio Site #1 el: 0 cu: CCU cg: RN v1: R Femoral st: NotStopd t0: [07:45:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [07:45:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 40 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [07:45:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 84 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [07:45:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [07:45:00 23/12/2015] id: Pericard Drain Site el: 0 cu: CCU cg: RN v1: Intact st: NotStopd t0: [07:45:00 23/12/2015] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [07:45:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [07:45:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [07:45:00 23/12/2015] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [07:45:00 23/12/2015] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [07:45:00 23/12/2015] id: Respiratory Effort el: 0 cu: CCU cg: RN v1: Normal st: NotStopd t0: [07:45:00 23/12/2015] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [07:45:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 12 u1: BPM st: NotStopd t0: [07:45:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [07:45:00 23/12/2015] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [07:45:00 23/12/2015] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [07:45:00 23/12/2015] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [07:45:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:45:00 23/12/2015] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [07:45:00 23/12/2015] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [07:45:00 23/12/2015] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:45:00 23/12/2015] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [07:45:00 23/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [07:45:00 23/12/2015] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 23/12/2015] id: Previous Weight el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd
t0: [07:45:00 23/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 189 vo: 3.75 vu: ml t0: [07:45:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CCU cg: RN ai: 109 vo: 6 vu: ml t0: [07:45:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 17.325 vu: ml t0: [07:45:00 23/12/2015] id: Urine Out Foley el: 1 cu: CCU cg: RN vo: 5 vu: ml
t0: [07:45:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:45:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 20.202 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 23/12/2015] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN cv: 0 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN cv: 2763.49 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN cv: 2803.49 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN cv: 2698.49 ap: none t0: [23:00:00 23/12/2015] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN cv: 3568.45 ap: carryForward
t0: [07:45:00 23/12/2015] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [07:45:00 23/12/2015] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [08:00:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 88 u1: BPM st: NotStopd t0: [08:00:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [08:00:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 40 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [08:00:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 82 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [08:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [08:00:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [08:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 16 u1: BPM st: NotStopd t0: [08:00:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 20.202 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:30:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [08:30:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:30:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:30:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:30:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 87 u1: BPM st: NotStopd t0: [08:30:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:30:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [08:30:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 39 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [08:30:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 78 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [08:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [08:30:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [08:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 12 u1: BPM st: NotStopd t0: [08:30:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [08:30:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:30:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:30:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 20.202 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [07:45:00 23/12/2015] id: Significant Events el: 0 cu: CCU cg: RN st: NotStopd t0: [08:45:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [08:45:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:45:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:45:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:45:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:45:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 87 u1: BPM st: NotStopd t0: [08:45:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:45:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 31 u1: mmHg st: NotStopd t0: [08:45:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 42 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [08:45:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 87 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [08:45:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [08:45:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:45:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [08:45:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 14 u1: BPM st: NotStopd t0: [08:45:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [08:45:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:45:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:45:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 20.202 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:00:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [09:00:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 87 u1: BPM st: NotStopd t0: [09:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 31 u1: mmHg st: NotStopd t0: [09:00:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 42 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [09:00:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 90 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [09:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [09:00:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [09:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 12 u1: BPM st: NotStopd t0: [09:00:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 93 u1: % st: NotStopd t0: [09:00:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:30:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [09:30:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:30:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 86 u1: BPM st: NotStopd t0: [09:30:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 31 u1: mmHg st: NotStopd t0: [09:30:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 42 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [09:30:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 89 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [09:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [09:30:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [09:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 12 u1: BPM st: NotStopd t0: [09:30:00 23/12/2015] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [09:30:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:45:00 23/12/2015] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [09:45:00 23/12/2015] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:45:00 23/12/2015] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:45:00 23/12/2015] id: Heart Rate el: 0 cu: CCU cg: RN v1: 84 u1: BPM st: NotStopd t0: [09:45:00 23/12/2015] id: PAP Mean el: 0 cu: CCU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [09:45:00 23/12/2015] id: PAP S/D el: 0 cu: CCU cg: RN v1: 41 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [09:45:00 23/12/2015] id: Arterial BP el: 0 cu: CCU cg: RN v1: 90 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [09:45:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [09:45:00 23/12/2015] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:45:00 23/12/2015] id: Previous Weight el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [09:45:00 23/12/2015] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 12 u1: BPM st: NotStopd t0: [09:45:00 23/12/2015] id: Significant Events el: 0 cu: CCU cg: RN v1: OR Sent st: NotStopd t0: [09:45:00 23/12/2015] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 23/12/2015] id: Previous Weight el: 0 cu: CCU cg: RN v1: 67.5 u1: kg st: NotStopd
t0: [09:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 20.202 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [09:30:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:30:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 20.202 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [09:45:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:45:00 23/12/2015] id: Propofol el: 1 cu: CCU cg: RN so: N/A vo: 0 v1: 20.202 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:59:00 23/12/2015] id: BSA el: 1033 cu: CCU cg: -1 v1: 1.71063 u1: m2 t0: [09:59:00 23/12/2015] id: Admit Wt el: 1032 cu: CCU cg: -1 v1: 66 u1: kg t0: [09:59:00 23/12/2015] id: Allergy 1 el: 1020 cu: CCU cg: -1 t0: [09:59:00 23/12/2015] id: Diagnosis/op el: 1023 cu: CCU cg: -1 v1: CONGESTIVE HEART FAILURE;TELEMETRY t0: [09:59:00 23/12/2015] id: Service el: 1026 cu: CCU cg: -1 v1: CSU t0: [09:59:00 23/12/2015] id: Admit Ht el: 1034 cu: CCU cg: -1 v1: 59 u1: inches t0: [09:59:00 23/12/2015] id: Readmission el: 1014 cu: CCU cg: -1 t0: [09:59:00 23/12/2015] id: Marital Status el: 1006 cu: CCU cg: -1 v1: M t0: [09:59:00 23/12/2015] id: Religion el: 1000 cu: CCU cg: -1 v1: NSP t0: [09:59:00 23/12/2015] id: Allergy 2 el: 1021 cu: CCU cg: -1 t0: [09:59:00 23/12/2015] id: Ext el: 1010 cu: CCU cg: -1 t0: [09:59:00 23/12/2015] id: PIN el: 1012 cu: CCU cg: -1 t0: [09:59:00 23/12/2015] id: Allergy 3 el: 1022 cu: CCU cg: -1
tf: [10:00:00 24/12/2015] pt: IV Piggyback rt: IV fr: ONCE fs: 11 dn: 1 m1: Voriconazole v1: 200 u1: mg m2: NS v2: 100 u2: ml
tf: [09:53:00 12/01/2016] dt: 28643 cu: CSRU de: CCU
t0: [14:00:00 23/12/2015] id: Peak Flow el: 0 cu: CSRU cg: -1 st: D/C'd
io: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ra: 80 ru: ml/hr
tf: [10:00:00 24/12/2015] pt: Unit Dose rt: SC fr: Q12H fs: 14, 2 dn: 2 m1: Heparin v1: 5000 u1: UNIT tf: [14:00:00 16/01/2016] pt: Unit Dose rt: IV fr: Q1H:PRN m1: Morphine Sulfate v1: 1-5 u1: mg tf: [10:00:00 28/01/2016] pt: IV Piggyback rt: IV fr: Q24H fs: 20 dn: 1 m1: Pantoprazole Sodium v1: 40 u1: mg m2: NS v2: 100 u2: ml
id: OR Crystalloid el: 1 cu: CSRU cg: RN io: OR Crystalloid OR Intake du: ml rt: Intravenous Push id: OR Packed RBC's el: 1 cu: CSRU cg: RN io: OR Packed RBC's OR Intake du: ml rt: Intravenous Push id: Lactated Ringers el: 1 cu: CSRU cg: RN io: Lactated Ringers IV Infusions du: ml rt: Intravenous Push
t0: [13:30:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:30:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:30:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:30:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:30:00 23/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [13:30:00 23/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:30:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 102 u1: BPM st: NotStopd t0: [13:30:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:30:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [13:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [13:30:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [13:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [13:30:00 23/12/2015] id: Significant Events el: 0 cu: CSRU cg: RN v1: OR Received st: NotStopd t0: [13:30:00 23/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [13:30:00 23/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.6667 u1: Deg. C st: NotStopd t0: [13:30:00 23/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.2 u1: Deg. F st: NotStopd t0: [13:30:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:45:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:45:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:45:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:45:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [13:45:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [13:45:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd
t0: [13:30:00 23/12/2015] tf: [13:45:00 23/12/2015] dt: 15 id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:30:00 23/12/2015] tf: [13:45:00 23/12/2015] dt: 15 id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 20.202 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [13:30:00 23/12/2015] tf: [09:53:00 12/01/2016] dt: 28583 id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:45:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped t0: [13:45:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 du: mcgkgmin sv: 50 su: vl rt: IV Drip st: Stopped
t0: [14:00:00 23/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [14:00:00 23/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 1 u1: torr st: NotStopd t0: [14:00:00 23/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [14:00:00 23/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [14:00:00 23/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [14:00:00 23/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT u1: Deg. C st: NotStopd t0: [14:00:00 23/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [14:00:00 23/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4 st: NotStopd t0: [14:00:00 23/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [14:00:00 23/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 5.6 u1: L/min st: NotStopd t0: [14:00:00 23/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [14:00:00 23/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [14:00:00 23/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: RRT v1: Not Applicable st: NotStopd t0: [14:00:00 23/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [14:00:00 23/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [14:00:00 23/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [14:00:00 23/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [14:00:00 23/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 280 u1: ml/B st: NotStopd t0: [14:00:00 23/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [14:00:00 23/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [14:00:00 23/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [14:18:00 23/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.2 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 69 u1: mmHg rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 387 u1: mmHg rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.2 rs: Final st: NotStopd
t0: [14:00:00 23/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: RRT v1: 100 u1: decFrc st: NotStopd t0: [14:00:00 23/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: RRT v1: 60 u1: decFrc st: NotStopd t0: [14:00:00 23/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: RRT v1: 33% st: NotStopd t0: [14:00:00 23/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT st: NotStopd t0: [14:00:00 23/12/2015] id: Drive Pres el: 0 cu: CSRU cg: RRT v1: 20 t0: [14:00:00 23/12/2015] id: PCV Exh Vt (Obser) el: 0 cu: CSRU cg: RRT v1: 280 u1: ml/B st: NotStopd t0: [14:00:00 23/12/2015] id: PCV Set Insp. Press el: 0 cu: CSRU cg: RRT v1: 20 u1: . st: NotStopd t0: [14:00:00 23/12/2015] id: Pause Time % el: 0 cu: CSRU cg: RRT v1: 0% st: NotStopd t0: [14:00:00 23/12/2015] id: Remote Alarm el: 0 cu: CSRU cg: RRT v1: No st: NotStopd t0: [14:00:00 23/12/2015] id: Working Pressure el: 0 cu: CSRU cg: RRT v1: 60 u1: cmH2O st: NotStopd t0: [14:18:00 23/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 101 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 101 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.18 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [13:10:00 23/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 11.2 rs: Final st: NotStopd t0: [13:10:00 23/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 11.2 rs: Final st: NotStopd t0: [13:10:00 23/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 31.3 u1: % rs: Final st: NotStopd t0: [13:10:00 23/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 9.9 u1: gm/dl rs: Final st: NotStopd t0: [13:10:00 23/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 402 rs: Final st: NotStopd t0: [13:10:00 23/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.43 u1: /mic l rs: Final st: NotStopd t0: [13:10:00 23/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 11.2 rs: Final st: NotStopd t0: [14:18:00 23/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.2004 u1: ml/dl st: NotStopd
t0: [14:30:00 23/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [14:30:00 23/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [14:30:00 23/12/2015] id: Drive Pres el: 0 cu: CSRU cg: RRT v1: 30 t0: [14:30:00 23/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [14:30:00 23/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [14:30:00 23/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [14:30:00 23/12/2015] id: PCV Exh Vt (Obser) el: 0 cu: CSRU cg: RRT v1: 400 u1: ml/B st: NotStopd t0: [14:30:00 23/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [14:30:00 23/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [14:30:00 23/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [13:30:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN u1: % st: NotStopd t0: [14:00:00 23/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 23/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 23/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [14:00:00 23/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [14:00:00 23/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [14:00:00 23/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 23/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [14:00:00 23/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 23/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 23/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [14:00:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 23/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 23/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 23/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 23/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 23/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Unarousable st: NotStopd t0: [14:00:00 23/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [14:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 23/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [14:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 23/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Altered LOC st: NotStopd t0: [14:00:00 23/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [14:00:00 23/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [14:00:00 23/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [14:00:00 23/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [14:00:00 23/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: ICU Environment st: NotStopd t0: [14:00:00 23/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [14:00:00 23/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [14:00:00 23/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 23/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: Flat in Bed st: NotStopd t0: [14:00:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 106 u1: BPM st: NotStopd t0: [14:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 23/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [14:00:00 23/12/2015] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 23/12/2015] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [14:00:00 23/12/2015] id: INV Line#3 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 23/12/2015] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [14:00:00 23/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft st: NotStopd t0: [14:00:00 23/12/2015] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 23/12/2015] id: INV#3 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [14:00:00 23/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [14:00:00 23/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [14:00:00 23/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [14:00:00 23/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 23/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 23/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [14:00:00 23/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [14:00:00 23/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [14:00:00 23/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 23/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [14:00:00 23/12/2015] id: Angio Appearance #1 el: 0 cu: CSRU cg: RN v1: Clean and Dry v2: Clean and Dry st: NotStopd t0: [14:00:00 23/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [14:00:00 23/12/2015] id: Angio Dressing #1 el: 0 cu: CSRU cg: RN v1: Transparent st: NotStopd t0: [14:00:00 23/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 23/12/2015] id: Angio Site #1 el: 0 cu: CSRU cg: RN v1: R Femoral st: NotStopd t0: [14:00:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 35 u1: mmHg st: NotStopd t0: [14:00:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 55 u1: mmHg v2: 26 u2: mmHg st: NotStopd t0: [14:00:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [14:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [14:00:00 23/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [14:00:00 23/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 23/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [14:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [14:00:00 23/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 23/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 23/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [14:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [14:00:00 23/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 23/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 23/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [14:00:00 23/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 23/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [14:00:00 23/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 23/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 23/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 23/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Anesthetized st: NotStopd t0: [14:00:00 23/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [14:00:00 23/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [14:00:00 23/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [14:00:00 23/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [14:00:00 23/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [14:00:00 23/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Very Poor st: NotStopd t0: [14:00:00 23/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 11 u1: number st: NotStopd t0: [14:00:00 23/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Comp. Limited st: NotStopd t0: [14:00:00 23/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [14:00:00 23/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [14:00:00 23/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 23/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 23/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [14:00:00 23/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [14:00:00 23/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:15:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:15:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:15:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:15:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:15:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:15:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 106 u1: BPM st: NotStopd t0: [14:15:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:15:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [14:15:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 50 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [14:15:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [14:15:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [14:15:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:15:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [14:15:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:30:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:30:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:30:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:30:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:30:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 106 u1: BPM st: NotStopd t0: [14:30:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:30:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [14:30:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 52 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [14:30:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [14:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [14:30:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [14:30:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 23/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 0 vu: ml t0: [14:00:00 23/12/2015] tf: [15:00:00 23/12/2015] dt: 60 id: OR Crystalloid OR Intake el: 1 cu: CSRU cg: RN ai: 107 vo: 1500 vu: ml t0: [14:00:00 23/12/2015] tf: [17:00:00 23/12/2015] dt: 180 id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CSRU cg: RN ai: 110 vo: 2.4 vu: ml t0: [14:00:00 23/12/2015] tf: [15:00:00 23/12/2015] dt: 60 id: OR Packed RBC's OR Intake el: 1 cu: CSRU cg: RN ai: 113 vo: 1100 vu: ml t0: [14:00:00 23/12/2015] tf: [18:00:00 23/12/2015] dt: 240 id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [14:00:00 23/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [14:00:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:15:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:30:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [15:00:00 23/12/2015] id: OR Crystalloid OR Intake el: 1 cu: CSRU cg: -1 ai: 107 vo: 0 st: D/C'd t0: [15:00:00 23/12/2015] id: OR Packed RBC's OR Intake el: 1 cu: CSRU cg: -1 ai: 113 vo: 0 st: D/C'd
t0: [14:21:00 23/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 56 rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 7.9 u1: mg/dl rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 107 rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.2 u1: mEq/L rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 56 rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 7.9 u1: mg/dl rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 107 rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.2 u1: mEq/L rs: Final st: NotStopd t0: [14:21:00 23/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd
t0: [14:00:00 23/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [14:15:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [14:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [14:45:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:45:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:45:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:45:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:45:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:45:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 101 u1: BPM st: NotStopd t0: [14:45:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:45:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 32 u1: mmHg st: NotStopd t0: [14:45:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 47 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [14:45:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [14:45:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [14:45:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:45:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [14:45:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [14:45:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 23/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [15:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 97 u1: BPM st: NotStopd t0: [15:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [15:00:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 45 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [15:00:00 23/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [15:00:00 23/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [15:00:00 23/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [15:00:00 23/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [15:00:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [15:00:00 23/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [15:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [15:00:00 23/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [15:00:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [15:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [15:00:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 94 u1: % st: NotStopd t0: [15:00:00 23/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [15:00:00 23/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2778 u1: Deg. C st: NotStopd t0: [15:00:00 23/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.3 u1: Deg. F st: NotStopd t0: [15:00:00 23/12/2015] id: Vent Sens/Capture el: 0 cu: CSRU cg: RN v1: No v2: Yes st: NotStopd t0: [15:00:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 23/12/2015] tf: [01:00:00 27/12/2015] dt: 4920 id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [15:00:00 23/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CSRU cg: RN ai: 110 vo: 2.475 vu: ml t0: [15:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [15:00:00 23/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 20 vu: ml t0: [15:00:00 23/12/2015] tf: [16:00:00 23/12/2015] dt: 60 id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 20 vu: ml
t0: [14:45:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 23/12/2015] tf: [09:53:00 12/01/2016] dt: 28493 id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [15:00:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [14:48:00 23/12/2015] id: PT el: 0 cu: CSRU cg: 3161 v1: 15.1 rs: Final st: NotStopd t0: [14:48:00 23/12/2015] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [14:48:00 23/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 37.6 rs: Final st: NotStopd t0: [14:48:00 23/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [14:48:00 23/12/2015] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 15.1 rs: Final st: NotStopd t0: [14:48:00 23/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 37.6 rs: Final st: NotStopd
t0: [15:20:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:20:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:20:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:20:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:20:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 95 u1: BPM st: NotStopd t0: [15:20:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:20:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 26 u1: mmHg st: NotStopd t0: [15:20:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 39 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [15:20:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [15:20:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:20:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [15:20:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [15:20:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:30:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:30:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:30:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:30:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:30:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 92 u1: BPM st: NotStopd t0: [15:30:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:30:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 32 u1: mmHg st: NotStopd t0: [15:30:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 47 u1: mmHg v2: 27 u2: mmHg st: NotStopd t0: [15:30:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [15:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [15:30:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [15:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [15:30:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [15:30:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:20:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [15:20:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:30:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [15:30:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [15:48:00 23/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.37 rs: Final st: NotStopd t0: [15:48:00 23/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -1 rs: Final st: NotStopd t0: [15:48:00 23/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [15:48:00 23/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 40 u1: mmHg rs: Final st: NotStopd t0: [15:48:00 23/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 224 u1: mmHg rs: Final st: NotStopd t0: [15:48:00 23/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.37 rs: Final st: NotStopd
t0: [16:00:00 23/12/2015] id: Cough Effort el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 23/12/2015] id: Cough Type el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 23/12/2015] id: Respiratory Effort el: 0 cu: CSRU cg: -1 st: D/C'd
tf: [13:00:00 23/12/2015] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Amiodarone HCl v1: 400 u1: mg tf: [11:00:00 26/12/2015] pt: IV Piggyback rt: IV fr: Q6H fs: 16, 22, 4, 10 dn: 4 m1: Unasyn v1: 3 u1: gm m2: NS v2: 100 u2: ml
id: Lactated Ringers el: 2 cu: CSRU cg: RN io: Lactated Ringers IV Infusions du: ml rt: Intravenous Push
t0: [15:40:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:40:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:40:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:40:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:40:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 91 u1: BPM st: NotStopd t0: [15:40:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:40:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [15:40:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 43 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [15:40:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [15:40:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [15:40:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:40:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [15:40:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [15:40:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [15:40:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:45:00 23/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [15:50:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:50:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:50:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:50:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:50:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 112 u1: BPM st: NotStopd t0: [15:50:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:50:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 37 u1: mmHg st: NotStopd t0: [15:50:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 53 u1: mmHg v2: 29 u2: mmHg st: NotStopd t0: [15:50:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [15:50:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [15:50:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:50:00 23/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [15:50:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [15:50:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [15:50:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [15:50:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:55:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:55:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:55:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:55:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 63 u1: BPM st: NotStopd t0: [15:55:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 37 u1: mmHg st: NotStopd t0: [15:55:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 54 u1: mmHg v2: 29 u2: mmHg st: NotStopd t0: [15:55:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 145 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [15:55:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [15:55:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:55:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [15:55:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [15:55:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 23/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 23/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 23/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 135 u1: BPM st: NotStopd t0: [16:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 37 u1: mmHg st: NotStopd t0: [16:00:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 54 u1: mmHg v2: 29 u2: mmHg st: NotStopd t0: [16:00:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 134 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [16:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [16:00:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [16:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [16:00:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:10:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 108 u1: BPM st: NotStopd t0: [16:10:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:10:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [16:10:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [16:10:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:10:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 23/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [16:00:00 23/12/2015] tf: [09:53:00 12/01/2016] dt: 28433 id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 110 vo: 7.0125 vu: ml t0: [16:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5.94 vu: ml
t0: [15:40:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [15:40:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:50:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [15:50:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:55:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [15:55:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [16:00:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:10:00 23/12/2015] tf: [08:00:00 24/12/2015] dt: 950 id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:10:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [14:00:00 23/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [14:00:00 23/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [14:00:00 23/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [14:00:00 23/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [15:20:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [16:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:15:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:15:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:15:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:15:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:15:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:15:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 100 u1: BPM st: NotStopd t0: [16:15:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:15:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [16:15:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 42 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [16:15:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [16:15:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [16:15:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:15:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [16:15:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [16:15:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:15:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:30:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:30:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:30:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:30:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:30:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 92 u1: BPM st: NotStopd t0: [16:30:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:30:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 38 u1: mmHg st: NotStopd t0: [16:30:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 58 u1: mmHg v2: 30 u2: mmHg st: NotStopd t0: [16:30:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 126 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [16:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [16:30:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [16:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [16:30:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:30:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 23/12/2015] tf: [09:00:00 24/12/2015] dt: 1020 id: Lactated Ringers IV Infusions el: 2 cu: CSRU cg: RN ai: 155 vo: 250 vu: ml t0: [16:00:00 23/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 5 vu: ml t0: [16:00:00 23/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [16:15:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:15:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [16:15:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:30:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:30:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [16:30:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [17:00:00 23/12/2015] id: Angio Appearance #1 el: 0 cu: CSRU cg: -1 st: D/C'd t0: [17:00:00 23/12/2015] id: Angio Dressing #1 el: 0 cu: CSRU cg: -1 st: D/C'd t0: [17:00:00 23/12/2015] id: Angio Site #1 el: 0 cu: CSRU cg: -1 st: D/C'd t0: [17:00:00 23/12/2015] id: Pericard Drain Site el: 0 cu: CSRU cg: -1 st: D/C'd
tf: [01:00:00 05/01/2016] pt: IV Piggyback rt: IV fr: PRN m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [01:00:00 05/01/2016] pt: Unit Dose rt: IV fr: PRN m1: Calcium Gluconate v1: 2 u1: gm tf: [01:00:00 05/01/2016] pt: Unit Dose rt: IV fr: PRN m1: Magnesium Sulfate v1: 2 u1: gm tf: [19:00:00 14/01/2016] pt: Unit Dose rt: PO fr: Q12H fs: 6, 18 dn: 2 m1: Voriconazole v1: 200 u1: mg tf: [20:00:00 23/01/2016] pt: Unit Dose rt: PO fr: Q12H fs: 6, 18 dn: 2 m1: Voriconazole v1: 200 u1: mg tf: [21:00:00 26/02/2016] pt: Unit Dose rt: PO fr: Q12H fs: 8, 20 dn: 2 m1: Voriconazole v1: 200 u1: mg
t0: [17:00:00 23/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [17:00:00 23/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: RRT v1: 70 u1: decFrc st: NotStopd t0: [17:00:00 23/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: RRT v1: 50 u1: decFrc st: NotStopd t0: [17:00:00 23/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [17:00:00 23/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: RRT v1: 33% st: NotStopd t0: [17:00:00 23/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [17:00:00 23/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 23/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 23/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT u1: Deg. C st: NotStopd t0: [17:00:00 23/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 23/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4 st: NotStopd t0: [17:00:00 23/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [17:00:00 23/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [17:00:00 23/12/2015] id: PCV Exh Vt (Obser) el: 0 cu: CSRU cg: RRT v1: 370 u1: ml/B st: NotStopd t0: [17:00:00 23/12/2015] id: PCV Insp Vt (Obser) el: 0 cu: CSRU cg: RRT v1: 374 u1: ml/B st: NotStopd t0: [17:00:00 23/12/2015] id: PCV Set Insp. Press el: 0 cu: CSRU cg: RRT v1: 30 u1: . st: NotStopd t0: [17:00:00 23/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 23/12/2015] id: Pause Time % el: 0 cu: CSRU cg: RRT v1: 0% st: NotStopd t0: [17:00:00 23/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [17:00:00 23/12/2015] id: Remote Alarm el: 0 cu: CSRU cg: RRT v1: No st: NotStopd t0: [17:00:00 23/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [17:00:00 23/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [17:00:00 23/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [17:00:00 23/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [17:00:00 23/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [17:00:00 23/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 23/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd t0: [17:00:00 23/12/2015] id: Working Pressure el: 0 cu: CSRU cg: RRT v1: 70 u1: cmH2O st: NotStopd
t0: [14:00:00 23/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [14:00:00 23/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [15:00:00 23/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 23/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 23/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 23/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 23/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/O2 Issues st: NotStopd t0: [16:00:00 23/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 23/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [16:00:00 23/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [16:00:00 23/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v2: ? st: NotStopd t0: [16:00:00 23/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 23/12/2015] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [16:00:00 23/12/2015] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 23/12/2015] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [16:00:00 23/12/2015] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [16:00:00 23/12/2015] id: INV Line#3 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 23/12/2015] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [16:00:00 23/12/2015] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 23/12/2015] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 23/12/2015] id: INV#3 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 23/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [16:00:00 23/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [16:00:00 23/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 23/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 23/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [16:00:00 23/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 23/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 23/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [16:00:00 23/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 23/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 23/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 23/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 23/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 23/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 23/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [16:00:00 23/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 23/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 23/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 23/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [16:45:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:45:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:45:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:45:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:45:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:45:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 91 u1: BPM st: NotStopd t0: [16:45:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:45:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 35 u1: mmHg st: NotStopd t0: [16:45:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 50 u1: mmHg v2: 28 u2: mmHg st: NotStopd t0: [16:45:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [16:45:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [16:45:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:45:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [16:45:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [16:45:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 89 u1: BPM st: NotStopd t0: [17:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [17:00:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 54 u1: mmHg v2: 25 u2: mmHg st: NotStopd t0: [17:00:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [17:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [17:00:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [17:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [17:00:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN u1: % st: NotStopd t0: [17:00:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 23/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [17:00:00 23/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CSRU cg: RN ai: 110 vo: 0 vu: ml t0: [17:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5.94 vu: ml t0: [17:00:00 23/12/2015] tf: [08:00:00 24/12/2015] dt: 900 id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 8 vu: ml t0: [17:00:00 23/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [17:00:00 23/12/2015] tf: [18:00:00 23/12/2015] dt: 60 id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 25 vu: ml
t0: [16:45:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:45:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [16:45:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [17:00:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [17:58:00 23/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.27 rs: Final st: NotStopd t0: [17:58:00 23/12/2015] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.9 rs: Final st: NotStopd t0: [17:58:00 23/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -3 rs: Final st: NotStopd t0: [17:58:00 23/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [17:58:00 23/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 52 u1: mmHg rs: Final st: NotStopd t0: [17:58:00 23/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 208 u1: mmHg rs: Final st: NotStopd t0: [17:58:00 23/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.27 rs: Final st: NotStopd t0: [17:58:00 23/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.15 rs: Final st: NotStopd t0: [17:58:00 23/12/2015] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.9 rs: Final st: NotStopd
t0: [17:00:00 23/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [17:00:00 23/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [17:00:00 23/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.2 u1: Deg. F st: NotStopd t0: [17:30:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:30:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:30:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:30:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:30:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [17:30:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:30:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [17:30:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 46 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [17:30:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [17:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [17:30:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [17:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [17:30:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 23/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [18:00:00 23/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [18:00:00 23/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 23/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [18:00:00 23/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 23/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [18:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [18:00:00 23/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 23/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 23/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [18:00:00 23/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd
t0: [18:00:00 23/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [18:00:00 23/12/2015] id: D5W 250.0ml + 400mcgkgmin Dopamine IV Infusions el: 1 cu: CSRU cg: RN ai: 110 vo: 0 vu: ml t0: [18:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5.94 vu: ml t0: [18:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 8.25 vu: ml t0: [18:00:00 23/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [18:00:00 23/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [17:30:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:30:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [17:30:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.8 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [17:45:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:45:00 23/12/2015] id: Cardiac Index el: 0 cu: CSRU cg: RN v1: 2.69006 u1: ... st: NotStopd t0: [17:45:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:45:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:45:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:45:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [17:45:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:45:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [17:45:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 46 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [17:45:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [17:45:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [17:45:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:45:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [17:45:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [17:45:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:45:00 23/12/2015] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CSRU cg: RN v1: 65 rs: Manual st: NotStopd t0: [17:45:00 23/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: RN v1: 100 u1: % rs: Manual st: NotStopd t0: [17:45:00 23/12/2015] id: C.O. (fick) el: 0 cu: CSRU cg: RN v1: 4.60361 u1: L/min st: NotStopd t0: [17:58:00 23/12/2015] id: CaO2 el: 0 cu: CSRU cg: RN v1: 13.9108 u1: ml/dl st: NotStopd t0: [17:58:00 23/12/2015] id: DO2I el: 0 cu: CSRU cg: RN v1: 376.6 u1: ml/m/m st: NotStopd t0: [18:00:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 87 u1: BPM st: NotStopd t0: [18:00:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [18:00:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 44 u1: mmHg v2: 20 u2: mmHg st: NotStopd t0: [18:00:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [18:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [18:00:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [18:00:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 23/12/2015] id: Lactated Ringers IV Infusions el: 2 cu: CSRU cg: RN ai: 155 vo: 250 vu: ml
t0: [17:45:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:45:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [17:45:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 23/12/2015] id: Dopamine el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [18:00:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [18:30:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:30:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:30:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:30:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [18:30:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:30:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 31 u1: mmHg st: NotStopd t0: [18:30:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 48 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [18:30:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [18:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [18:30:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [18:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [18:30:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:30:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.8 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:30:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [11:00:00 14/02/2016] pt: Unit Dose rt: OU fr: PRN m1: Lacri-Lube Oint v1: 1 u1: Appl
t0: [19:00:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [19:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [19:00:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 41 u1: mmHg v2: 17 u2: mmHg st: NotStopd t0: [19:00:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [19:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [19:00:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [19:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [19:00:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [19:00:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 23/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [19:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 7.92 vu: ml t0: [19:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 13.2 vu: ml t0: [19:00:00 23/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [19:00:00 23/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [19:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.8 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [19:16:00 23/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [19:16:00 23/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 83 rs: Final st: NotStopd t0: [19:16:00 23/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.6 rs: Final st: NotStopd t0: [19:16:00 23/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [19:16:00 23/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [19:16:00 23/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 35 u1: mmHg rs: Final st: NotStopd t0: [19:16:00 23/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 258 u1: mmHg rs: Final st: NotStopd t0: [19:16:00 23/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [19:16:00 23/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 83 rs: Final st: NotStopd t0: [19:16:00 23/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.6 rs: Final st: NotStopd
t0: [14:00:00 23/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [14:00:00 23/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [15:00:00 23/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [18:00:00 23/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [18:00:00 23/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [18:00:00 23/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [18:00:00 23/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [19:00:00 23/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd
t0: [20:00:00 23/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: -1 st: D/C'd
tf: [07:00:00 25/12/2015] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Fentanyl Citrate v1: 2500 u1: mcg m2: D5W v2: 250 u2: ml tf: [11:00:00 25/12/2015] pt: IV Piggyback rt: IV fr: Q12H fs: 11, 23 dn: 2 m1: Vancomycin HCl v1: 1000 u1: mg m2: Iso-Osmotic Dextrose v2: 200 u2: ml tf: [16:00:00 31/12/2015] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Fentanyl Citrate v1: 2500 u1: mcg m2: Soln. v2: 50 u2: ml
t0: [20:00:00 23/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 23/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: CRT v1: 70 u1: decFrc st: NotStopd t0: [20:00:00 23/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: CRT v1: 50 u1: decFrc st: NotStopd t0: [20:00:00 23/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: CRT v1: 0.6 u1: torr st: NotStopd t0: [20:00:00 23/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: CRT v1: 33% st: NotStopd t0: [20:00:00 23/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 23/12/2015] id: Airway Size el: 0 cu: CSRU cg: CRT v1: 7.5 mm st: NotStopd t0: [20:00:00 23/12/2015] id: Airway Type el: 0 cu: CSRU cg: CRT v1: Endotracheal st: NotStopd t0: [20:00:00 23/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: CRT u1: Deg. C st: NotStopd t0: [20:00:00 23/12/2015] id: Intubation Date el: 0 cu: CSRU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 23/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: CRT v1: 7 st: NotStopd t0: [20:00:00 23/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: CRT v1: 15.1 u1: cmH2O st: NotStopd t0: [20:00:00 23/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: CRT v1: 12.6 u1: L/min st: NotStopd t0: [20:00:00 23/12/2015] id: PCV Exh Vt (Obser) el: 0 cu: CSRU cg: CRT v1: 497 u1: ml/B st: NotStopd t0: [20:00:00 23/12/2015] id: PCV Insp Vt (Obser) el: 0 cu: CSRU cg: CRT v1: 511 u1: ml/B st: NotStopd t0: [20:00:00 23/12/2015] id: PCV Set Insp. Press el: 0 cu: CSRU cg: CRT v1: 30 u1: . st: NotStopd t0: [20:00:00 23/12/2015] id: PEEP Set el: 0 cu: CSRU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 23/12/2015] id: Pause Time % el: 0 cu: CSRU cg: CRT v1: 0% st: NotStopd t0: [20:00:00 23/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 35 u1: cmH2O st: NotStopd t0: [20:00:00 23/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: CRT v1: 35 u1: cmH2O st: NotStopd t0: [20:00:00 23/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: CRT v1: Yes st: NotStopd t0: [20:00:00 23/12/2015] id: Remote Alarm el: 0 cu: CSRU cg: CRT v1: No st: NotStopd t0: [20:00:00 23/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: CRT v1: 1 u1: BPM st: NotStopd t0: [20:00:00 23/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: CRT v1: 26 u1: BPM st: NotStopd t0: [20:00:00 23/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: CRT v1: 25 u1: BPM st: NotStopd t0: [20:00:00 23/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: CRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: CRT v1: 95 u1: % st: NotStopd t0: [20:00:00 23/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: CRT v1: 492 u1: ml/B st: NotStopd t0: [20:00:00 23/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: CRT v1: Pressure Control st: NotStopd t0: [20:00:00 23/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: CRT v1: SQUARE st: NotStopd t0: [20:00:00 23/12/2015] id: Working Pressure el: 0 cu: CSRU cg: CRT v1: 70 u1: cmH2O st: NotStopd
id: Fentanyl el: 100 cu: CSRU cg: RN io: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions am: 2500 du: mcghr rt: IV Drip
id: .9% Normal Saline el: 1 cu: CSRU cg: RN io: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [21:54:00 23/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 110 rs: Final st: NotStopd t0: [21:54:00 23/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [21:54:00 23/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [21:54:00 23/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 21 rs: Final st: NotStopd t0: [21:54:00 23/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 28 u1: mmHg rs: Final st: NotStopd t0: [21:54:00 23/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 273 u1: mmHg rs: Final st: NotStopd t0: [21:54:00 23/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 110 rs: Final st: NotStopd t0: [21:54:00 23/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd
t0: [22:00:00 23/12/2015] id: PCV Exh Vt (Obser) el: 0 cu: CSRU cg: -1 st: D/C'd t0: [22:00:00 23/12/2015] id: PCV Insp Vt (Obser) el: 0 cu: CSRU cg: -1 st: D/C'd t0: [22:00:00 23/12/2015] id: PCV Set Insp. Press el: 0 cu: CSRU cg: -1 st: D/C'd t0: [22:00:00 23/12/2015] id: Remote Alarm el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [19:30:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:30:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:30:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [19:30:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 23 u1: mmHg st: NotStopd t0: [19:30:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 38 u1: mmHg v2: 16 u2: mmHg st: NotStopd t0: [19:30:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [19:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [19:30:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [19:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [19:30:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 92 u1: % st: NotStopd t0: [19:30:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 23/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 23/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 23/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 23/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 23/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 23/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 23/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 23/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 23/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 23/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 23/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [20:00:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 23/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 23/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 23/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 23/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 23/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/O2 Issues st: NotStopd t0: [20:00:00 23/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 23/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [20:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 23/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 23/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 23/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 23/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient/Sig Othr st: NotStopd t0: [20:00:00 23/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [20:00:00 23/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [20:00:00 23/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: ICU Environment st: NotStopd t0: [20:00:00 23/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 23/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Fam Talked to RN st: NotStopd t0: [20:00:00 23/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [20:00:00 23/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 23/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 23/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 89 u1: BPM st: NotStopd t0: [20:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 23/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [20:00:00 23/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 23/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: Serous v2: Scant st: NotStopd t0: [20:00:00 23/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 23/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 23/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 23/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 23/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 23/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 23/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 23/12/2015] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [20:00:00 23/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 23/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [20:00:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 47 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [20:00:00 23/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [20:00:00 23/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [20:00:00 23/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [20:00:00 23/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [20:00:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [20:00:00 23/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [20:00:00 23/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [20:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [20:00:00 23/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 23/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [20:00:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 23/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [20:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [20:00:00 23/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 23/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [20:00:00 23/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 23/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 23/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [20:00:00 23/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 23/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 23/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 23/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 23/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [20:00:00 23/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [20:00:00 23/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [20:00:00 23/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 23/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 23/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36 u1: Deg. C st: NotStopd t0: [20:00:00 23/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.8 u1: Deg. F st: NotStopd t0: [20:00:00 23/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Amber v2: Clear st: NotStopd t0: [20:00:00 23/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 23/12/2015] id: Vent Sens/Capture el: 0 cu: CSRU cg: RN v1: Yes v2: Yes st: NotStopd t0: [20:00:00 23/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 23/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 23/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [20:00:00 23/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 23/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: No Apparent Prob st: NotStopd t0: [20:00:00 23/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 23/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 23/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 23/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 13 u1: number st: NotStopd t0: [20:00:00 23/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 23/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 23/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 23/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 23/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 23/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 23/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 23/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:30:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:30:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:30:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:30:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 89 u1: BPM st: NotStopd t0: [20:30:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [20:30:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 42 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [20:30:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [20:30:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [20:30:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:30:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [20:30:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [20:30:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [20:30:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 91 u1: BPM st: NotStopd t0: [21:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [21:00:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 42 u1: mmHg v2: 20 u2: mmHg st: NotStopd t0: [21:00:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [21:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [21:00:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 23/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [21:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [21:00:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 23/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 23/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 23/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 23/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 23/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [22:00:00 23/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [22:00:00 23/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [22:00:00 23/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [22:00:00 23/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [22:00:00 23/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [22:00:00 23/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [22:00:00 23/12/2015] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [22:00:00 23/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 23/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 23/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 23/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 23/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 23/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [22:00:00 23/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd
t0: [20:00:00 23/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [20:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 9.9 vu: ml t0: [20:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 14.85 vu: ml t0: [20:00:00 23/12/2015] tf: [21:00:00 23/12/2015] dt: 60 id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [20:00:00 23/12/2015] tf: [21:00:00 23/12/2015] dt: 60 id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 30 vu: ml t0: [21:00:00 23/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [21:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 15.84 vu: ml t0: [21:00:00 23/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 23/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [21:00:00 23/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [22:00:00 23/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [22:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 15.84 vu: ml t0: [22:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 24.75 vu: ml t0: [22:00:00 23/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 23/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [22:00:00 23/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [19:30:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:30:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [20:00:00 23/12/2015] tf: [09:53:00 12/01/2016] dt: 28193 id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [20:30:00 23/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:30:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:30:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [21:00:00 23/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 23/12/2015] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 20 ap: none
t0: [20:00:00 23/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: CRT v1: Servo 900c st: NotStopd t0: [22:00:00 23/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [22:00:00 23/12/2015] id: Airway Size el: 0 cu: CSRU cg: CRT v1: 7.5 mm st: NotStopd t0: [22:00:00 23/12/2015] id: Airway Type el: 0 cu: CSRU cg: CRT v1: Endotracheal st: NotStopd t0: [22:00:00 23/12/2015] id: Intubation Date el: 0 cu: CSRU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [22:00:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: CRT v1: 93 u1: % st: NotStopd
t0: [22:00:00 23/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: CRT v1: 15.1515 u1: ml/cmH st: NotStopd t0: [22:00:00 23/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: CRT v1: 0.5 u1: torr st: NotStopd t0: [22:00:00 23/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: CRT v1: 33% st: NotStopd t0: [22:00:00 23/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [22:00:00 23/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: CRT u1: Deg. C st: NotStopd t0: [22:00:00 23/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: CRT v1: 5 st: NotStopd t0: [22:00:00 23/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: CRT v1: 10.6 u1: cmH2O st: NotStopd t0: [22:00:00 23/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: CRT v1: 10 u1: L/min st: NotStopd t0: [22:00:00 23/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: CRT v1: 5.9 u1: L/min st: NotStopd t0: [22:00:00 23/12/2015] id: PEEP Set el: 0 cu: CSRU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [22:00:00 23/12/2015] id: Pause Time % el: 0 cu: CSRU cg: CRT v1: 0% st: NotStopd t0: [22:00:00 23/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: CRT v1: 30.303 u1: lpm st: NotStopd t0: [22:00:00 23/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 38 u1: cmH2O st: NotStopd t0: [22:00:00 23/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: CRT v1: 34 u1: cmH2O st: NotStopd t0: [22:00:00 23/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: CRT v1: Yes st: NotStopd t0: [22:00:00 23/12/2015] id: Pressure Support el: 0 cu: CSRU cg: CRT v1: 5 u1: . st: NotStopd t0: [22:00:00 23/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: CRT v1: 0 u1: BPM st: NotStopd t0: [22:00:00 23/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: CRT v1: 12 u1: BPM st: NotStopd t0: [22:00:00 23/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: CRT v1: 12 u1: BPM st: NotStopd t0: [22:00:00 23/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: CRT v1: 2 u1: cmH2O st: NotStopd t0: [22:00:00 23/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [22:00:00 23/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [22:00:00 23/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: CRT v1: SIMV+PS st: NotStopd t0: [22:00:00 23/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: CRT v1: 7 u1: # st: NotStopd t0: [22:00:00 23/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: CRT v1: Servo 900c st: NotStopd t0: [22:00:00 23/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: CRT v1: SQUARE st: NotStopd t0: [22:00:00 23/12/2015] id: Working Pressure el: 0 cu: CSRU cg: CRT v1: 65 u1: cmH2O st: NotStopd
t0: [20:00:00 23/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [20:00:00 23/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [20:00:00 23/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [22:00:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 91 u1: BPM st: NotStopd t0: [22:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 26 u1: mmHg st: NotStopd t0: [22:00:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 42 u1: mmHg v2: 18 u2: mmHg st: NotStopd t0: [22:00:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [22:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [22:00:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [22:00:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 23/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 23/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 23/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 23/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 23/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 23/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [23:00:00 23/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 23/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [23:00:00 23/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 45 u1: mmHg v2: 19 u2: mmHg st: NotStopd t0: [23:00:00 23/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [23:00:00 23/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 23/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [23:00:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 23/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 23/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [23:00:00 23/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 23/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:55:00 23/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.36 rs: Final st: NotStopd t0: [22:55:00 23/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 95 rs: Final st: NotStopd t0: [22:55:00 23/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [22:55:00 23/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -1 rs: Final st: NotStopd t0: [22:55:00 23/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [22:55:00 23/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 43 u1: mmHg rs: Final st: NotStopd t0: [22:55:00 23/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 198 u1: mmHg rs: Final st: NotStopd t0: [22:55:00 23/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.36 rs: Final st: NotStopd t0: [22:55:00 23/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 95 rs: Final st: NotStopd t0: [22:55:00 23/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd
t0: [20:00:00 23/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 23/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v2: ? st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#3 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [20:00:00 23/12/2015] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 23/12/2015] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 23/12/2015] id: INV#3 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 23/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [20:00:00 23/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [20:00:00 23/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 23/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 23/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 23/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Normal st: NotStopd t0: [20:00:00 23/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 23/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 23/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 23/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [20:00:00 23/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 23/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 23/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 23/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 23/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [21:54:00 23/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: RN v1: 7.48 rs: Final st: NotStopd t0: [21:54:00 23/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [21:54:00 23/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [21:54:00 23/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [21:54:00 23/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [21:54:00 23/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 92 u1: % st: NotStopd t0: [21:54:00 23/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Servo 900c st: NotStopd t0: [21:54:00 23/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: RN v1: 7.48 rs: Final st: NotStopd t0: [22:00:00 23/12/2015] id: ETT Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 23/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [22:00:00 23/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 23/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 23/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 23/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 23/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [22:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [22:00:00 23/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [23:00:00 23/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [23:00:00 23/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd
t0: [23:00:00 23/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [23:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 24.75 vu: ml t0: [23:00:00 23/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 23/12/2015] tf: [01:00:00 24/12/2015] dt: 120 id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 15 vu: ml t0: [23:00:00 23/12/2015] tf: [01:00:00 24/12/2015] dt: 120 id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 5 vu: ml
t0: [23:00:00 23/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.75 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 23/12/2015] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 120 cv: 120 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 50 cv: 381 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 120 cv: 901 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN pv: 70 cv: 520 ap: none
t0: [20:00:00 23/12/2015] tf: [09:53:00 12/01/2016] dt: 28193 id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml nb: 1 t0: [21:00:00 23/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 21.45 vu: ml nb: 1 t0: [23:00:00 23/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 15.84 vu: ml nb: 1
t0: [23:00:00 23/12/2015] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: 5.59 cv: 5.59 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 125.59 cv: 4713.79 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 125.59 cv: 7373.79 ap: none t0: [23:00:00 23/12/2015] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: 5.59 cv: 6472.79 ap: none t0: [23:00:00 23/12/2015] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: 5.59 cv: 7342.75 ap: carryForward
t0: [00:00:00 24/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: CRT v1: 15.1515 u1: ml/cmH st: NotStopd t0: [00:00:00 24/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 24/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: CRT v1: 0.5 u1: torr st: NotStopd t0: [00:00:00 24/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: CRT v1: 33% st: NotStopd t0: [00:00:00 24/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 24/12/2015] id: Airway Size el: 0 cu: CSRU cg: CRT v1: 7.5 mm st: NotStopd t0: [00:00:00 24/12/2015] id: Airway Type el: 0 cu: CSRU cg: CRT v1: Endotracheal st: NotStopd t0: [00:00:00 24/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: CRT u1: Deg. C st: NotStopd t0: [00:00:00 24/12/2015] id: Intubation Date el: 0 cu: CSRU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 24/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: CRT v1: 5 st: NotStopd t0: [00:00:00 24/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: CRT v1: 10.5 u1: cmH2O st: NotStopd t0: [00:00:00 24/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: CRT v1: 10 u1: L/min st: NotStopd t0: [00:00:00 24/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: CRT v1: 5.9 u1: L/min st: NotStopd t0: [00:00:00 24/12/2015] id: PEEP Set el: 0 cu: CSRU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 24/12/2015] id: Pause Time % el: 0 cu: CSRU cg: CRT v1: 0% st: NotStopd t0: [00:00:00 24/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: CRT v1: 30.303 u1: lpm st: NotStopd t0: [00:00:00 24/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 38 u1: cmH2O st: NotStopd t0: [00:00:00 24/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: CRT v1: 32 u1: cmH2O st: NotStopd t0: [00:00:00 24/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: CRT v1: Yes st: NotStopd t0: [00:00:00 24/12/2015] id: Pressure Support el: 0 cu: CSRU cg: CRT v1: 5 u1: . st: NotStopd t0: [00:00:00 24/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: CRT v1: 0 u1: BPM st: NotStopd t0: [00:00:00 24/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: CRT v1: 12 u1: BPM st: NotStopd t0: [00:00:00 24/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: CRT v1: 12 u1: BPM st: NotStopd t0: [00:00:00 24/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: CRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: CRT v1: 99 u1: % st: NotStopd t0: [00:00:00 24/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: CRT v1: 518 u1: ml/B st: NotStopd t0: [00:00:00 24/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [00:00:00 24/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: CRT v1: SIMV+PS st: NotStopd t0: [00:00:00 24/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: CRT v1: 7 u1: # st: NotStopd t0: [00:00:00 24/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: CRT v1: Servo 900c st: NotStopd t0: [00:00:00 24/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: CRT v1: SQUARE st: NotStopd t0: [00:00:00 24/12/2015] id: Working Pressure el: 0 cu: CSRU cg: CRT v1: 65 u1: cmH2O st: NotStopd
t0: [21:54:00 23/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: RN v1: 1.05 rs: Final st: NotStopd t0: [00:00:00 24/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 24/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 24/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 24/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 24/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 24/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 24/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [00:00:00 24/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 24/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 24/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 24/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 24/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 24/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 24/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 24/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 24/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [00:00:00 24/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/O2 Issues st: NotStopd t0: [00:00:00 24/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 24/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 24/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [00:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 24/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 24/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 24/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [00:00:00 24/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [00:00:00 24/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 24/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [00:00:00 24/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [00:00:00 24/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 24/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [00:00:00 24/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [00:00:00 24/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 24/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 24/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 89 u1: BPM st: NotStopd t0: [00:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 24/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 24/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 24/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v2: ? st: NotStopd t0: [00:00:00 24/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [00:00:00 24/12/2015] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [00:00:00 24/12/2015] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [00:00:00 24/12/2015] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 24/12/2015] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [00:00:00 24/12/2015] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [00:00:00 24/12/2015] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 24/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 24/12/2015] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 24/12/2015] id: INV#3 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 24/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [00:00:00 24/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [00:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 24/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 24/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: Serous v2: Scant st: NotStopd t0: [00:00:00 24/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 24/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 24/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 24/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 24/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [00:00:00 24/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 24/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [00:00:00 24/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [00:00:00 24/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 24/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [00:00:00 24/12/2015] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [00:00:00 24/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 24/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 24/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [00:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 48 u1: mmHg v2: 19 u2: mmHg st: NotStopd t0: [00:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 24/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [00:00:00 24/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [00:00:00 24/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [00:00:00 24/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [00:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [00:00:00 24/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [00:00:00 24/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [00:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [00:00:00 24/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 24/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [00:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [00:00:00 24/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 24/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [00:00:00 24/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [00:00:00 24/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [00:00:00 24/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [00:00:00 24/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [00:00:00 24/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 24/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 24/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [00:00:00 24/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 24/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 24/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 24/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 24/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 24/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [00:00:00 24/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 24/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 24/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.7778 u1: Deg. C st: NotStopd t0: [00:00:00 24/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.4 u1: Deg. F st: NotStopd t0: [00:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 24/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Amber v2: Clear st: NotStopd t0: [00:00:00 24/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 24/12/2015] id: Vent Sens/Capture el: 0 cu: CSRU cg: RN v1: Yes v2: Yes st: NotStopd t0: [00:00:00 24/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 24/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 24/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 24/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [00:00:00 24/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 24/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [00:00:00 24/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 24/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 24/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 24/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 24/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [01:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [01:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [01:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 47 u1: mmHg v2: 18 u2: mmHg st: NotStopd t0: [01:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [01:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [01:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [01:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [01:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [00:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 15.84 vu: ml t0: [00:00:00 24/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 28.875 vu: ml t0: [00:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [01:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 15.84 vu: ml t0: [01:00:00 24/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 28.875 vu: ml t0: [01:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 24/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [01:00:00 24/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [00:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.75 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [01:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.75 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [22:00:00 23/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 24/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [02:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 24/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [02:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [02:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [02:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [02:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [02:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [02:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 44 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [02:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [02:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [02:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [02:00:00 24/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [02:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [02:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [02:00:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [02:00:00 24/12/2015] id: Significant Events el: 0 cu: CSRU cg: RN v1: Fluid Bolus st: NotStopd t0: [02:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [02:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [02:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 15.84 vu: ml t0: [02:00:00 24/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 28.875 vu: ml t0: [02:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml
t0: [02:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [23:00:00 24/12/2015] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 40 cv: 40 ap: none t0: [23:00:00 24/12/2015] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: 98.3175 cv: 98.3175 ap: none t0: [23:00:00 24/12/2015] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 108.317 cv: 3001.88 ap: none t0: [23:00:00 24/12/2015] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 138.318 cv: 3281.88 ap: none t0: [23:00:00 24/12/2015] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 40 cv: 820 ap: none t0: [23:00:00 24/12/2015] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: 98.3175 cv: 2069.88 ap: none t0: [23:00:00 24/12/2015] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 40 cv: 1212 ap: none t0: [23:00:00 24/12/2015] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 392 ap: none t0: [23:00:00 24/12/2015] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: 98.3175 cv: 9412.62 ap: carryForward
t0: [00:00:00 24/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [00:00:00 24/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [02:00:00 24/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [02:00:00 24/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [02:00:00 24/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [02:00:00 24/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [02:00:00 24/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [02:00:00 24/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [02:00:00 24/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [02:00:00 24/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [02:00:00 24/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [02:00:00 24/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [02:00:00 24/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [02:00:00 24/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [02:00:00 24/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [02:00:00 24/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [02:00:00 24/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [02:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [02:00:00 24/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [02:00:00 24/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [03:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [03:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 32 u1: mmHg st: NotStopd t0: [03:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 46 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [03:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [03:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [03:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [03:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [03:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [03:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 15.84 vu: ml t0: [03:00:00 24/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 33 vu: ml t0: [03:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml
t0: [03:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:52:00 24/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.33 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 91 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 134 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 191 u1: mmHg rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.33 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 91 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.14 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [03:52:00 24/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 134 rs: Final st: NotStopd
t0: [03:55:00 24/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 32 u1: % rs: Final st: NotStopd
t0: [02:00:00 24/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [02:00:00 24/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [02:00:00 24/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 24/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [02:00:00 24/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [02:00:00 24/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [02:00:00 24/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [02:00:00 24/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [02:00:00 24/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 24/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [02:00:00 24/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 24/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 24/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [02:00:00 24/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 24/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 24/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 24/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 24/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 24/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 24/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 24/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 24/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [04:00:00 24/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 24/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 24/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 24/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 24/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 24/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 24/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 24/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [04:00:00 24/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 24/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [04:00:00 24/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [04:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 24/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 24/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 24/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [04:00:00 24/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [04:00:00 24/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 24/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 24/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [04:00:00 24/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 24/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [04:00:00 24/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [04:00:00 24/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 24/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 24/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [04:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 24/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 24/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 24/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v2: ? st: NotStopd t0: [04:00:00 24/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [04:00:00 24/12/2015] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [04:00:00 24/12/2015] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [04:00:00 24/12/2015] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 24/12/2015] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [04:00:00 24/12/2015] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [04:00:00 24/12/2015] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 24/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 24/12/2015] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 24/12/2015] id: INV#3 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 24/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [04:00:00 24/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [04:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 24/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 24/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: Serous v2: Scant st: NotStopd t0: [04:00:00 24/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 24/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 24/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 24/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 24/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [04:00:00 24/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 24/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [04:00:00 24/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [04:00:00 24/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 24/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [04:00:00 24/12/2015] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [04:00:00 24/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 24/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 24/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [04:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 39 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [04:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 24/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [04:00:00 24/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [04:00:00 24/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [04:00:00 24/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [04:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [04:00:00 24/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [04:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [04:00:00 24/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [04:00:00 24/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 24/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [04:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [04:00:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [04:00:00 24/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [04:00:00 24/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [04:00:00 24/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [04:00:00 24/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 24/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [04:00:00 24/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [04:00:00 24/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 24/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 24/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 24/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 24/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 24/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 24/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 24/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [04:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 24/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 24/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 24/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36 u1: Deg. C st: NotStopd t0: [04:00:00 24/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.8 u1: Deg. F st: NotStopd t0: [04:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [04:00:00 24/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Amber v2: Clear st: NotStopd t0: [04:00:00 24/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 24/12/2015] id: Vent Sens/Capture el: 0 cu: CSRU cg: RN v1: Yes v2: Yes st: NotStopd t0: [04:00:00 24/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 24/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 24/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [04:00:00 24/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 24/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [04:00:00 24/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 24/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 24/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 24/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 24/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [04:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [04:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 15.84 vu: ml t0: [04:00:00 24/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 33 vu: ml t0: [04:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 24/12/2015] tf: [09:00:00 24/12/2015] dt: 300 id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [04:00:00 24/12/2015] tf: [06:00:00 24/12/2015] dt: 120 id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 35 vu: ml
t0: [04:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:50:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:50:00 24/12/2015] id: Cardiac Index el: 0 cu: CSRU cg: RN v1: 3.04094 u1: ... st: NotStopd t0: [03:50:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:50:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:50:00 24/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [03:50:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [03:50:00 24/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [03:50:00 24/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [03:50:00 24/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [03:50:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 35 u1: mmHg st: NotStopd t0: [03:50:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 42 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [03:50:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [03:50:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [03:50:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:50:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [03:50:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [03:50:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:50:00 24/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: RN v1: 7 u1: # st: NotStopd t0: [03:50:00 24/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Servo 900c st: NotStopd t0: [03:50:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:50:00 24/12/2015] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CSRU cg: RN v1: 71 rs: Manual st: NotStopd t0: [03:50:00 24/12/2015] id: C.O. (fick) el: 0 cu: CSRU cg: RN v1: 5.18916 u1: L/min st: NotStopd t0: [03:55:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:55:00 24/12/2015] id: Cardiac Index el: 0 cu: CSRU cg: RN v1: 3.04094 u1: ... st: NotStopd t0: [03:55:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:55:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:55:00 24/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [03:55:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [03:55:00 24/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [03:55:00 24/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [03:55:00 24/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [03:55:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [03:55:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 39 u1: mmHg v2: 24 u2: mmHg st: NotStopd t0: [03:55:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [03:55:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [03:55:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:55:00 24/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [03:55:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [03:55:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [03:55:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:55:00 24/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 0 u1: Deg. F st: NotStopd t0: [03:55:00 24/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: RN v1: 7 u1: # st: NotStopd t0: [03:55:00 24/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Servo 900c st: NotStopd t0: [03:55:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:55:00 24/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: RN v1: 10.6 u1: gm/dl rs: Manual st: NotStopd t0: [03:55:00 24/12/2015] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CSRU cg: RN v1: 71 rs: Manual st: NotStopd t0: [03:55:00 24/12/2015] id: C.O. (fick) el: 0 cu: CSRU cg: RN v1: 5.18916 u1: L/min st: NotStopd
t0: [03:50:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:50:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:50:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:55:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:55:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:55:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [03:56:00 24/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 14.2 rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 14.2 rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 32.5 u1: % rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.1 u1: gm/dl rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 442 rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.58 u1: /mic l rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 14.2 rs: Final st: NotStopd
t0: [03:56:00 24/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 55 rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8 u1: mg/dl rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 2 rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 u1: mEq/L rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 55 rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8 u1: mg/dl rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2 rs: Final st: NotStopd t0: [03:56:00 24/12/2015] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 u1: mEq/L rs: Final st: NotStopd
id: Levophed-k el: 100 cu: CSRU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions am: 4 du: mcgkgmin rt: IV Drip
id: D5W el: 1 cu: CSRU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [22:00:00 23/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: CRT v1: 60 u1: decFrc st: NotStopd t0: [22:00:00 23/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: CRT v1: 40 u1: decFrc st: NotStopd t0: [00:00:00 24/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: CRT v1: 60 u1: decFrc st: NotStopd t0: [00:00:00 24/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: CRT v1: 40 u1: decFrc st: NotStopd t0: [05:00:00 24/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: CRT v1: 14.2857 u1: ml/cmH st: NotStopd t0: [05:00:00 24/12/2015] id: RSBI Not Completed el: 0 cu: CSRU cg: CRT v1: No Spon Resp st: NotStopd t0: [05:00:00 24/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [05:00:00 24/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: CRT v1: 60 u1: decFrc st: NotStopd t0: [05:00:00 24/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: CRT v1: 40 u1: decFrc st: NotStopd t0: [05:00:00 24/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: CRT v1: 0.5 u1: torr st: NotStopd t0: [05:00:00 24/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: CRT v1: 33% st: NotStopd t0: [05:00:00 24/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [05:00:00 24/12/2015] id: Airway Size el: 0 cu: CSRU cg: CRT v1: 7.5 mm st: NotStopd t0: [05:00:00 24/12/2015] id: Airway Type el: 0 cu: CSRU cg: CRT v1: Endotracheal st: NotStopd t0: [05:00:00 24/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: CRT u1: Deg. C st: NotStopd t0: [05:00:00 24/12/2015] id: Intubation Date el: 0 cu: CSRU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 24/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: CRT v1: 5 st: NotStopd t0: [05:00:00 24/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: CRT v1: 10 u1: cmH2O st: NotStopd t0: [05:00:00 24/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: CRT v1: 10 u1: L/min st: NotStopd t0: [05:00:00 24/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: CRT v1: 6 u1: L/min st: NotStopd t0: [05:00:00 24/12/2015] id: PEEP Set el: 0 cu: CSRU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 24/12/2015] id: Pause Time % el: 0 cu: CSRU cg: CRT v1: 0% st: NotStopd t0: [05:00:00 24/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: CRT v1: 30.303 u1: lpm st: NotStopd t0: [05:00:00 24/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 40 u1: cmH2O st: NotStopd t0: [05:00:00 24/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: CRT v1: 36 u1: cmH2O st: NotStopd t0: [05:00:00 24/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: CRT v1: Yes st: NotStopd t0: [05:00:00 24/12/2015] id: Pressure Support el: 0 cu: CSRU cg: CRT v1: 5 u1: . st: NotStopd t0: [05:00:00 24/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: CRT v1: 12 u1: BPM st: NotStopd t0: [05:00:00 24/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: CRT v1: 2 u1: cmH2O st: NotStopd t0: [05:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: CRT v1: 100 u1: % st: NotStopd t0: [05:00:00 24/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [05:00:00 24/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: CRT v1: 500 u1: ml/B st: NotStopd t0: [05:00:00 24/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: CRT v1: SIMV+PS st: NotStopd t0: [05:00:00 24/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: CRT v1: 7 u1: # st: NotStopd t0: [05:00:00 24/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: CRT v1: Servo 900c st: NotStopd t0: [05:00:00 24/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: CRT v1: RAMP st: NotStopd t0: [05:00:00 24/12/2015] id: Working Pressure el: 0 cu: CSRU cg: CRT v1: 65 u1: cmH2O st: NotStopd
t0: [03:30:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:30:00 24/12/2015] id: Cardiac Index el: 0 cu: CSRU cg: RN v1: 3.04094 u1: ... st: NotStopd t0: [03:30:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:30:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:30:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [03:30:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [03:30:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 43 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [03:30:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [03:30:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [03:30:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:30:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [03:30:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [03:30:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:30:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [04:30:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:30:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:30:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:30:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [04:30:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [04:30:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 40 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [04:30:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [04:30:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [04:30:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:30:00 24/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [04:30:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [04:30:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [04:30:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [04:30:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 89 u1: BPM st: NotStopd t0: [05:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [05:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 45 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [05:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [05:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [05:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 24/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [05:00:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [05:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [05:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:15:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:15:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:15:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:15:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 90 u1: BPM st: NotStopd t0: [05:15:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [05:15:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 44 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [05:15:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [05:15:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [05:15:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:15:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [05:15:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [05:15:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [05:15:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:30:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:30:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:30:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:30:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:30:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 92 u1: BPM st: NotStopd t0: [05:30:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:30:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 26 u1: mmHg st: NotStopd t0: [05:30:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 41 u1: mmHg v2: 17 u2: mmHg st: NotStopd t0: [05:30:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [05:30:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [05:30:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:30:00 24/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [05:30:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [05:30:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [05:30:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [05:30:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:45:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:45:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:45:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:45:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:45:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 96 u1: BPM st: NotStopd t0: [05:45:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:45:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 26 u1: mmHg st: NotStopd t0: [05:45:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 43 u1: mmHg v2: 18 u2: mmHg st: NotStopd t0: [05:45:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [05:45:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [05:45:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:45:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [05:45:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [05:45:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [05:45:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 98 u1: BPM st: NotStopd t0: [06:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [06:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 46 u1: mmHg v2: 18 u2: mmHg st: NotStopd t0: [06:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [06:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [06:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [06:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [06:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:05:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:05:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:05:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:05:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 100 u1: BPM st: NotStopd t0: [06:05:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [06:05:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 50 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [06:05:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 131 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [06:05:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [06:05:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:05:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [06:05:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [06:05:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 93 u1: % st: NotStopd t0: [06:05:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:10:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:10:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:10:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:10:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:10:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 100 u1: BPM st: NotStopd t0: [06:10:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:10:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [06:10:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 50 u1: mmHg v2: 20 u2: mmHg st: NotStopd t0: [06:10:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 121 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [06:10:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [06:10:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:10:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [06:10:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [06:10:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:10:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:15:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:15:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:15:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:15:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 99 u1: BPM st: NotStopd t0: [06:15:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [06:15:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 48 u1: mmHg v2: 19 u2: mmHg st: NotStopd t0: [06:15:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 113 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [06:15:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [06:15:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:15:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [06:15:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [06:15:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:15:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:30:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:15:00 24/12/2015] tf: [04:30:00 27/12/2015] dt: 4275 id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:30:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 40 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:30:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:30:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 2.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:30:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 25 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [05:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 2.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 25 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [05:15:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:15:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:15:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 2.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:15:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 25 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [05:30:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:30:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:30:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 2.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:30:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 25 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [05:45:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:45:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.083 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:45:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:45:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 25 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [06:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.083 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:05:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:05:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.083 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:05:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:05:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 35 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [06:10:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:10:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.083 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:10:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:10:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 35 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [06:15:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:15:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.083 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:15:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:15:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 35 du: mcgkgmin sv: 50 su: vl rt: IV Drip
tf: [20:00:00 24/12/2015] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Norepinephrine v1: 4 u1: mg m2: D5W v2: 250 u2: ml tf: [05:00:00 25/12/2015] pt: Unit Dose rt: IV fr: ONCE fs: 6 dn: 1 m1: Furosemide v1: 10 u1: mg tf: [07:00:00 25/12/2015] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO dn: 0 m1: Norepinephrine v1: 8 u1: mg m2: D5W v2: 250 u2: ml tf: [22:00:00 25/12/2015] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Norepinephrine v1: 16 u1: mg m2: D5W v2: 250 u2: ml tf: [16:00:00 31/12/2015] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Norepinephrine v1: 32 u1: mg m2: D5W v2: 250 u2: ml
t0: [04:00:00 24/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/O2 Issues st: NotStopd t0: [04:00:00 24/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 24/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [04:00:00 24/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [04:00:00 24/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [04:00:00 24/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [04:00:00 24/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: RN v1: 7 u1: # st: NotStopd t0: [04:00:00 24/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Servo 900c st: NotStopd t0: [05:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 24/12/2015] id: Significant Events el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [06:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [06:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 24/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 24/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [06:00:00 24/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 24/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd
t0: [06:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd
t0: [06:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 35 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [06:21:00 24/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.36 rs: Final st: NotStopd t0: [06:21:00 24/12/2015] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [06:21:00 24/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -1 rs: Final st: NotStopd t0: [06:21:00 24/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [06:21:00 24/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 41 u1: mmHg rs: Final st: NotStopd t0: [06:21:00 24/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 185 u1: mmHg rs: Final st: NotStopd t0: [06:21:00 24/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.36 rs: Final st: NotStopd t0: [06:21:00 24/12/2015] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd
t0: [05:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [05:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10.89 vu: ml nb: 1 t0: [05:00:00 24/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 37.125 vu: ml t0: [05:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [06:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 9.9 vu: ml t0: [06:00:00 24/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 35.0625 vu: ml t0: [06:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml
t0: [06:00:00 24/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [06:00:00 24/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [05:00:00 24/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RN u1: BPM st: NotStopd t0: [05:00:00 24/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd
tf: [06:00:00 25/12/2015] pt: Unit Dose rt: IV fr: ONCE fs: 7 dn: 1 m1: Furosemide v1: 40 u1: mg
t0: [07:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 101 u1: BPM st: NotStopd t0: [07:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 25 u1: mmHg st: NotStopd t0: [07:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 43 u1: mmHg v2: 16 u2: mmHg st: NotStopd t0: [07:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [07:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [07:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 24/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.5 u1: kg st: NotStopd t0: [07:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [07:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [07:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 13.86 vu: ml t0: [07:00:00 24/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 4.8125 vu: ml t0: [07:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml
t0: [07:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.083 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 35 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 24/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 24/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 24/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 24/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 24/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 24/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 24/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 24/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 24/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 24/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 24/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 24/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 24/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 24/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 24/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 24/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [08:00:00 24/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [08:00:00 24/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 24/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 96 rs: Manual st: NotStopd t0: [08:00:00 24/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [08:00:00 24/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [08:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 24/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 24/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 24/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [08:00:00 24/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [08:00:00 24/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 24/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 24/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 102 u1: BPM st: NotStopd t0: [08:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 24/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [08:00:00 24/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 24/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v2: ? st: NotStopd t0: [08:00:00 24/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [08:00:00 24/12/2015] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [08:00:00 24/12/2015] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [08:00:00 24/12/2015] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 24/12/2015] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [08:00:00 24/12/2015] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [08:00:00 24/12/2015] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 24/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 24/12/2015] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 24/12/2015] id: INV#3 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 24/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [08:00:00 24/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [08:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 24/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 24/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None v2: Scant st: NotStopd t0: [08:00:00 24/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 24/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 24/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 24/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 24/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [08:00:00 24/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 24/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [08:00:00 24/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 24/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 24/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [08:00:00 24/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 24/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 25 u1: mmHg st: NotStopd t0: [08:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 41 u1: mmHg v2: 17 u2: mmHg st: NotStopd t0: [08:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 24/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [08:00:00 24/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [08:00:00 24/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [08:00:00 24/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [08:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [08:00:00 24/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [08:00:00 24/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [08:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [08:00:00 24/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [08:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 24/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [08:00:00 24/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [08:00:00 24/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [08:00:00 24/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 24/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [08:00:00 24/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 24/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 24/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 24/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 24/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 24/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 24/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 24/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [08:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 24/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 24/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 24/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [08:00:00 24/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [08:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [08:00:00 24/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 24/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 24/12/2015] id: Vent Sens/Capture el: 0 cu: CSRU cg: RN v1: Yes v2: Yes st: NotStopd t0: [08:00:00 24/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 24/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 24/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [08:00:00 24/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: RN v1: 96 rs: Manual st: NotStopd t0: [08:00:00 24/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 24/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 24/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 24/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 24/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 24/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 24/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [08:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [08:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 13.86 vu: ml t0: [08:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml
t0: [08:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 35 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 24/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: RN ai: 153 vo: 4.125 vu: ml st: Stopped
t0: [08:00:00 24/12/2015] id: Neosynephrine-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped
t0: [08:30:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:30:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:30:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:30:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 103 u1: BPM st: NotStopd t0: [08:30:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 25 u1: mmHg st: NotStopd t0: [08:30:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 40 u1: mmHg v2: 17 u2: mmHg st: NotStopd t0: [08:30:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [08:30:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [08:30:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:30:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [08:30:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:30:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:30:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.12 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:30:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 35 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [09:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 106 u1: BPM st: NotStopd t0: [09:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 26 u1: mmHg st: NotStopd t0: [09:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 41 u1: mmHg v2: 18 u2: mmHg st: NotStopd t0: [09:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [09:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [09:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 17 u1: BPM st: NotStopd t0: [09:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [09:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [09:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 13.86 vu: ml t0: [09:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml t0: [09:00:00 24/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [09:00:00 24/12/2015] tf: [15:00:00 26/12/2015] dt: 3240 id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 40 vu: ml
t0: [09:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 35 du: mcgkgmin sv: 50 su: vl rt: IV Drip
id: Levophed-k el: 101 cu: CSRU cg: RN io: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips am: 8 du: mcgkgmin rt: IV Drip
io: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ra: 17.325 ru: ml/hr
t0: [09:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 2 cu: CSRU cg: -1 ai: 155 vo: 0 st: D/C'd
id: D5W el: 1 cu: CSRU cg: RN io: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips vo: 250 du: ml rt: Intravenous Push
t0: [10:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [10:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 31 u1: mmHg st: NotStopd t0: [10:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 55 u1: mmHg v2: 21 u2: mmHg st: NotStopd t0: [10:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [10:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [10:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [10:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 24/12/2015] tf: [09:53:00 12/01/2016] dt: 27473 id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 0 vu: ml t0: [08:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 20.5425 vu: ml t0: [09:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 27.225 vu: ml t0: [10:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 10 vu: ml t0: [10:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 13.86 vu: ml t0: [10:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 17.325 vu: ml t0: [10:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml
t0: [10:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 35 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [10:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd
t0: [10:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.13 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [10:00:00 24/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.3333 u1: ml/cmH st: NotStopd t0: [10:00:00 24/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [10:00:00 24/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: RRT v1: 60 u1: decFrc st: NotStopd t0: [10:00:00 24/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: RRT v1: 40 u1: decFrc st: NotStopd t0: [10:00:00 24/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [10:00:00 24/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: RRT v1: 33% st: NotStopd t0: [10:00:00 24/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [10:00:00 24/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [10:00:00 24/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [10:00:00 24/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT u1: Deg. C st: NotStopd t0: [10:00:00 24/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [10:00:00 24/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4 st: NotStopd t0: [10:00:00 24/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 10.2 u1: cmH2O st: NotStopd t0: [10:00:00 24/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [10:00:00 24/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 5.8 u1: L/min st: NotStopd t0: [10:00:00 24/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [10:00:00 24/12/2015] id: Pause Time % el: 0 cu: CSRU cg: RRT v1: 0% st: NotStopd t0: [10:00:00 24/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: RRT v1: 26.6667 u1: lpm st: NotStopd t0: [10:00:00 24/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [10:00:00 24/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [10:00:00 24/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: RRT v1: Yes st: NotStopd t0: [10:00:00 24/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [10:00:00 24/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [10:00:00 24/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [10:00:00 24/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [10:00:00 24/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [10:00:00 24/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [10:00:00 24/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [10:00:00 24/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [10:00:00 24/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: RRT v1: 7 u1: # st: NotStopd t0: [10:00:00 24/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Servo 900c st: NotStopd t0: [10:00:00 24/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd t0: [10:00:00 24/12/2015] id: Working Pressure el: 0 cu: CSRU cg: RRT v1: 65 u1: cmH2O st: NotStopd
t0: [10:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 0 vu: ml
tf: [20:00:00 24/12/2015] pt: IV Piggyback rt: IV fr: ASDIR m1: Heparin Sodium v1: 25000 u1: UNIT m2: D5W v2: 250 u2: ml
t0: [08:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [11:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 115 u1: BPM st: NotStopd t0: [11:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [11:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: RN v1: 51 u1: mmHg v2: 18 u2: mmHg st: NotStopd t0: [11:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [11:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [11:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [11:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 10 vu: ml t0: [11:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 13.86 vu: ml t0: [11:00:00 24/12/2015] tf: [05:00:00 28/12/2015] dt: 5400 id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 10 vu: ml t0: [11:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 16.0875 vu: ml t0: [11:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml
t0: [11:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 35 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [11:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.15 du: mcgkgmin sv: 250 su: ml rt: IV Drip
id: Heparin el: 200 cu: CSRU cg: RN io: D5W 250.0ml + 25000Uhr Heparin IV Infusions am: 25000 du: Uhr rt: IV Drip
t0: [12:00:00 24/12/2015] id: Cardiac Index el: 0 cu: CSRU cg: -1 st: D/C'd t0: [12:00:00 24/12/2015] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: -1 st: D/C'd t0: [12:00:00 24/12/2015] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: -1 st: D/C'd t0: [12:00:00 24/12/2015] id: INV Line#3 Zero/Cal el: 0 cu: CSRU cg: -1 st: D/C'd t0: [12:00:00 24/12/2015] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: -1 st: D/C'd t0: [12:00:00 24/12/2015] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: -1 st: D/C'd t0: [12:00:00 24/12/2015] id: INV#3 WaveformAppear el: 0 cu: CSRU cg: -1 st: D/C'd t0: [12:00:00 24/12/2015] id: PAP Mean el: 0 cu: CSRU cg: -1 st: D/C'd t0: [12:00:00 24/12/2015] id: PAP S/D el: 0 cu: CSRU cg: -1 st: D/C'd t0: [12:00:00 24/12/2015] id: C.O. (fick) el: 0 cu: CSRU cg: -1 st: D/C'd
io: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ra: 6 ru: ml/hr
id: D5W el: 2 cu: CSRU cg: RN io: D5W 250.0ml + 25000Uhr Heparin IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [08:00:00 24/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 24/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [10:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [12:00:00 24/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 24/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 24/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 24/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 24/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 24/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [12:00:00 24/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 24/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 24/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 24/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 24/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 24/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 24/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 24/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 24/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [12:00:00 24/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 24/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [12:00:00 24/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [12:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 24/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 24/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 24/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 24/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [12:00:00 24/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 24/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [12:00:00 24/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Called st: NotStopd t0: [12:00:00 24/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [12:00:00 24/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 24/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 24/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 117 u1: BPM st: NotStopd t0: [12:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 24/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v2: ? st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: PA line v2: Right Femoral st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Femoral st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 22 st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 24/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 24/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 24/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [12:00:00 24/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [12:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 24/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 24/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [12:00:00 24/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [12:00:00 24/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 24/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 24/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 24/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [12:00:00 24/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 24/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 24/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [12:00:00 24/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 24/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 24/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 24/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [12:00:00 24/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [12:00:00 24/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [12:00:00 24/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [12:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [12:00:00 24/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [12:00:00 24/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [12:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 57 u1: mmHg st: NotStopd t0: [12:00:00 24/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 24/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [12:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [12:00:00 24/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [12:00:00 24/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [12:00:00 24/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [12:00:00 24/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 24/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [12:00:00 24/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 24/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 24/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [12:00:00 24/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 24/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 24/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [12:00:00 24/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 24/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 24/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [12:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 24/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 24/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 24/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [12:00:00 24/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [12:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [12:00:00 24/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 24/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 24/12/2015] id: Vent Sens/Capture el: 0 cu: CSRU cg: RN v1: Yes v2: Yes st: NotStopd t0: [12:00:00 24/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 24/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 24/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 24/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [12:00:00 24/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 24/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [12:00:00 24/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 24/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 24/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 24/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 24/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [12:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 10 vu: ml t0: [12:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 13.86 vu: ml t0: [12:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 10 vu: ml t0: [12:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 18.5625 vu: ml t0: [12:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml
t0: [12:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 0 vu: ml
t0: [12:00:00 24/12/2015] tf: [09:53:00 12/01/2016] dt: 27233 id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 600 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.18 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [12:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [12:48:00 24/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.28 rs: Final st: NotStopd t0: [12:48:00 24/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.7903 u1: ml/dl st: NotStopd t0: [12:48:00 24/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [12:48:00 24/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [12:48:00 24/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [12:48:00 24/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 51 u1: mmHg rs: Final st: NotStopd t0: [12:48:00 24/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 170 u1: mmHg rs: Final st: NotStopd t0: [12:48:00 24/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.28 rs: Final st: NotStopd t0: [12:48:00 24/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.13 rs: Final st: NotStopd t0: [12:48:00 24/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [12:48:00 24/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [13:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RRT v1: CSRU st: NotStopd t0: [13:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RRT v1: Full Code st: NotStopd t0: [13:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RRT v1: Yes st: NotStopd t0: [13:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RRT v1: None st: NotStopd t0: [13:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RRT v1: None st: NotStopd t0: [13:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RRT v1: 119 u1: BPM st: NotStopd t0: [13:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RRT v1: Sinus Tachy st: NotStopd t0: [13:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RRT v1: 84 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [13:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RRT v1: 59 u1: mmHg st: NotStopd t0: [13:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RRT v1: Universal st: NotStopd t0: [13:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [13:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RRT v1: 1 u1: kg st: NotStopd
t0: [13:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RRT ai: 109 vo: 10 vu: ml t0: [13:00:00 24/12/2015] tf: [13:00:00 31/12/2015] dt: 10080 id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RRT ai: 168 vo: 6 vu: ml t0: [13:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RRT ai: 107 vo: 11.88 vu: ml t0: [13:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RRT ai: 109 vo: 10 vu: ml t0: [13:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RRT ai: 338 vo: 22.275 vu: ml t0: [13:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RRT ai: 107 vo: 2.5 vu: ml
t0: [13:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RRT so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RRT so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RRT so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [13:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RRT so: D5W vo: 0 v1: 600 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:00:00 24/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [13:00:00 24/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: RRT v1: 60 u1: decFrc st: NotStopd t0: [13:00:00 24/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: RRT v1: 40 u1: decFrc st: NotStopd t0: [13:00:00 24/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [13:00:00 24/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: RRT v1: 33% st: NotStopd t0: [13:00:00 24/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [13:00:00 24/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:00:00 24/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [13:00:00 24/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [13:00:00 24/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4 st: NotStopd t0: [13:00:00 24/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [13:00:00 24/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:00:00 24/12/2015] id: Pause Time % el: 0 cu: CSRU cg: RRT v1: 0% st: NotStopd t0: [13:00:00 24/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: RRT v1: 26.6667 u1: lpm st: NotStopd t0: [13:00:00 24/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: RRT v1: Yes st: NotStopd t0: [13:00:00 24/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [13:00:00 24/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [13:00:00 24/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [13:00:00 24/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [13:00:00 24/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [13:00:00 24/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: RRT v1: 7 u1: # st: NotStopd t0: [13:00:00 24/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Servo 900c st: NotStopd t0: [13:00:00 24/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd t0: [13:00:00 24/12/2015] id: Working Pressure el: 0 cu: CSRU cg: RRT v1: 65 u1: cmH2O st: NotStopd
t0: [13:00:00 24/12/2015] tf: [22:00:00 25/12/2015] dt: 1980 id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 20 vu: ml t0: [13:00:00 24/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 40 vu: ml
t0: [13:30:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:30:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:30:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:30:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:30:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:30:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 120 u1: BPM st: NotStopd t0: [13:30:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:30:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [13:30:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 55 u1: mmHg st: NotStopd t0: [13:30:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:30:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [13:30:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [13:30:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:30:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:30:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:30:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [13:30:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 600 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:40:00 24/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.26 rs: Final st: NotStopd t0: [13:40:00 24/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.7686 u1: ml/dl st: NotStopd t0: [13:40:00 24/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [13:40:00 24/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [13:40:00 24/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 56 u1: mmHg rs: Final st: NotStopd t0: [13:40:00 24/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 163 u1: mmHg rs: Final st: NotStopd t0: [13:40:00 24/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.26 rs: Final st: NotStopd t0: [13:40:00 24/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [13:00:00 24/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 7.2 u1: L/min st: NotStopd t0: [13:00:00 24/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [13:00:00 24/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [13:00:00 24/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd
t0: [13:00:00 24/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 12.5714 u1: ml/cmH st: NotStopd t0: [13:00:00 24/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 11.4 u1: cmH2O st: NotStopd t0: [13:00:00 24/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [13:00:00 24/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd
t0: [14:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 127 u1: BPM st: NotStopd t0: [14:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [14:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [14:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [14:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 6 vu: ml t0: [14:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [14:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 10 vu: ml t0: [14:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 27.8438 vu: ml t0: [14:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml
t0: [14:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [14:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 600 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [14:47:00 24/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.31 rs: Final st: NotStopd t0: [14:47:00 24/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [14:47:00 24/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [14:47:00 24/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 47 u1: mmHg rs: Final st: NotStopd t0: [14:47:00 24/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 164 u1: mmHg rs: Final st: NotStopd t0: [14:47:00 24/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.31 rs: Final st: NotStopd
t0: [14:47:00 24/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.7717 u1: ml/dl st: NotStopd t0: [14:47:00 24/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [15:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 125 u1: BPM st: NotStopd t0: [15:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [15:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [15:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [15:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 6 vu: ml t0: [15:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [15:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 10 vu: ml t0: [15:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [15:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [15:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [15:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 600 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 24/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [14:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [15:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [16:00:00 24/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 24/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 24/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 24/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 24/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 24/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [16:00:00 24/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 24/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 24/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 24/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 24/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 24/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 24/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 24/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 24/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [16:00:00 24/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 24/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [16:00:00 24/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [16:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 24/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 24/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 24/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 24/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [16:00:00 24/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [16:00:00 24/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Called st: NotStopd t0: [16:00:00 24/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [16:00:00 24/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 24/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 24/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 126 u1: BPM st: NotStopd t0: [16:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 24/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 24/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 24/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 24/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 24/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 24/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 24/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 24/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 24/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 24/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 24/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [16:00:00 24/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 24/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [16:00:00 24/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [16:00:00 24/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 24/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [16:00:00 24/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 24/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 24/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [16:00:00 24/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [16:00:00 24/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [16:00:00 24/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [16:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [16:00:00 24/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [16:00:00 24/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [16:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [16:00:00 24/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 24/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [16:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 24/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [16:00:00 24/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [16:00:00 24/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [16:00:00 24/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 24/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [16:00:00 24/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 24/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 24/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [16:00:00 24/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 24/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 24/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 24/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 24/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [16:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 24/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 24/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [16:00:00 24/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.4 u1: Deg. F st: NotStopd t0: [16:00:00 24/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 24/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 24/12/2015] id: Vent Sens/Capture el: 0 cu: CSRU cg: RN v1: Yes v2: Yes st: NotStopd t0: [16:00:00 24/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 24/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [16:00:00 24/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 24/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [16:00:00 24/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 24/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 24/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 24/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 24/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [16:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [16:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 6 vu: ml t0: [16:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [16:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 20 vu: ml t0: [16:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [16:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [16:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [16:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 600 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [14:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [16:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd
t0: [16:42:00 24/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.33 rs: Final st: NotStopd t0: [16:42:00 24/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.6787 u1: ml/dl st: NotStopd t0: [16:42:00 24/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [16:42:00 24/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [16:42:00 24/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [16:42:00 24/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 134 u1: mmHg rs: Final st: NotStopd t0: [16:42:00 24/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.33 rs: Final st: NotStopd t0: [16:42:00 24/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [17:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 123 u1: BPM st: NotStopd t0: [17:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [17:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [17:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [17:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 6 vu: ml t0: [17:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [17:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [17:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [17:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [17:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 600 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:00:00 24/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 12.2222 u1: ml/cmH st: NotStopd t0: [17:00:00 24/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [17:00:00 24/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: RRT v1: 60 u1: decFrc st: NotStopd t0: [17:00:00 24/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: RRT v1: 40 u1: decFrc st: NotStopd t0: [17:00:00 24/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 24/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: RRT v1: 25% st: NotStopd t0: [17:00:00 24/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [17:00:00 24/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 24/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 24/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT u1: Deg. C st: NotStopd t0: [17:00:00 24/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 24/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4 st: NotStopd t0: [17:00:00 24/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 11.1 u1: cmH2O st: NotStopd t0: [17:00:00 24/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [17:00:00 24/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.3 u1: L/min st: NotStopd t0: [17:00:00 24/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 24/12/2015] id: Pause Time % el: 0 cu: CSRU cg: RRT v1: 0% st: NotStopd t0: [17:00:00 24/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: RRT v1: 35.2 u1: lpm st: NotStopd t0: [17:00:00 24/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 41 u1: cmH2O st: NotStopd t0: [17:00:00 24/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [17:00:00 24/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: RRT v1: Yes st: NotStopd t0: [17:00:00 24/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [17:00:00 24/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [17:00:00 24/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [17:00:00 24/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [17:00:00 24/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [17:00:00 24/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 445 u1: ml/B st: NotStopd t0: [17:00:00 24/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [17:00:00 24/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [17:00:00 24/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: RRT v1: 7 u1: # st: NotStopd t0: [17:00:00 24/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Servo 900c st: NotStopd t0: [17:00:00 24/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd t0: [17:00:00 24/12/2015] id: Working Pressure el: 0 cu: CSRU cg: RRT v1: 65 u1: cmH2O st: NotStopd
t0: [17:59:00 24/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd t0: [17:59:00 24/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.7004 u1: ml/dl st: NotStopd t0: [17:59:00 24/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -1 rs: Final st: NotStopd t0: [17:59:00 24/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [17:59:00 24/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 43 u1: mmHg rs: Final st: NotStopd t0: [17:59:00 24/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 141 u1: mmHg rs: Final st: NotStopd t0: [17:59:00 24/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd t0: [17:59:00 24/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [17:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [18:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 122 u1: BPM st: NotStopd t0: [18:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [18:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [18:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [18:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 20 vu: ml t0: [18:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [18:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 6 vu: ml t0: [18:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [18:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 20 vu: ml t0: [18:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [18:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [18:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [18:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 600 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [19:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 121 u1: BPM st: NotStopd t0: [19:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [19:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [19:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [19:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [19:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 6 vu: ml t0: [19:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [19:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 20 vu: ml t0: [19:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [19:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml t0: [19:00:00 24/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 20 vu: ml t0: [19:00:00 24/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 15 vu: ml
t0: [19:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [19:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 600 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:45:00 23/12/2015] id: Previous WeightF el: 0 cu: CCU cg: 3161 u1: kg st: NotStopd t0: [14:00:00 24/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 101 rs: Manual st: NotStopd t0: [14:00:00 24/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: RN v1: 101 rs: Manual st: NotStopd t0: [18:16:00 24/12/2015] id: PT el: 0 cu: CSRU cg: 3161 v1: 16.1 rs: Final st: NotStopd t0: [18:16:00 24/12/2015] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [18:16:00 24/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 40 rs: Final st: NotStopd t0: [18:16:00 24/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [18:16:00 24/12/2015] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 16.1 rs: Final st: NotStopd t0: [18:16:00 24/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 40 rs: Final st: NotStopd
t0: [16:00:00 24/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [16:00:00 24/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v2: ? st: NotStopd t0: [16:00:00 24/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 24/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [16:00:00 24/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [16:00:00 24/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [18:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [18:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd
t0: [19:30:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:30:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:30:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:30:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:30:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:30:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 121 u1: BPM st: NotStopd t0: [19:30:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:30:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [19:30:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [19:30:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:30:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [19:30:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 93 u1: % st: NotStopd t0: [19:30:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:30:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:30:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:30:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [19:30:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 700 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 24/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 24/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 24/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 24/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 24/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 24/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 24/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 24/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 24/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 24/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 24/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 24/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 24/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 24/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 24/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [20:00:00 24/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 24/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 24/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 24/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 24/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [20:00:00 24/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 24/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 24/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 24/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 24/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [20:00:00 24/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [20:00:00 24/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 24/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 24/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 24/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 24/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 24/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 24/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [20:00:00 24/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [20:00:00 24/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 24/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 24/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 24/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 24/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 24/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 24/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 24/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 24/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 24/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 24/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [20:00:00 24/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 24/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 24/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 24/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 24/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [20:00:00 24/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [20:00:00 24/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [20:00:00 24/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [20:00:00 24/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [20:00:00 24/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 24/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 24/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 24/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 24/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 24/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 24/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 24/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 24/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 24/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 24/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [20:00:00 24/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 24/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [20:00:00 24/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 24/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 24/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 24/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 24/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 24/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [20:00:00 24/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 24/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 24/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 24/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 24/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 24/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 12 u1: number st: NotStopd t0: [20:00:00 24/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 24/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 24/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [20:00:00 24/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 24/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 24/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 24/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 24/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [20:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [20:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 6.5 vu: ml t0: [20:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [20:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 20 vu: ml t0: [20:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [20:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [20:00:00 24/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: CRT v1: 12.5714 u1: ml/cmH st: NotStopd t0: [20:00:00 24/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 24/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: CRT v1: 50 u1: decFrc st: NotStopd t0: [20:00:00 24/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: CRT v1: 30 u1: decFrc st: NotStopd t0: [20:00:00 24/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 24/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: CRT v1: 25% st: NotStopd t0: [20:00:00 24/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 24/12/2015] id: Airway Size el: 0 cu: CSRU cg: CRT v1: 7.5 mm st: NotStopd t0: [20:00:00 24/12/2015] id: Airway Type el: 0 cu: CSRU cg: CRT v1: Endotracheal st: NotStopd t0: [20:00:00 24/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: CRT u1: Deg. C st: NotStopd t0: [20:00:00 24/12/2015] id: Intubation Date el: 0 cu: CSRU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 24/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: CRT v1: 4 st: NotStopd t0: [20:00:00 24/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: CRT v1: 12.1 u1: cmH2O st: NotStopd t0: [20:00:00 24/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: CRT v1: 8.8 u1: L/min st: NotStopd t0: [20:00:00 24/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: CRT v1: 8.3 u1: L/min st: NotStopd t0: [20:00:00 24/12/2015] id: PEEP Set el: 0 cu: CSRU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 24/12/2015] id: Pause Time % el: 0 cu: CSRU cg: CRT v1: 0% st: NotStopd t0: [20:00:00 24/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: CRT v1: 35.2 u1: lpm st: NotStopd t0: [20:00:00 24/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 24/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: CRT v1: 36 u1: cmH2O st: NotStopd t0: [20:00:00 24/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: CRT v1: Yes st: NotStopd t0: [20:00:00 24/12/2015] id: Pressure Support el: 0 cu: CSRU cg: CRT v1: 5 u1: . st: NotStopd t0: [20:00:00 24/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: CRT v1: 0 u1: BPM st: NotStopd t0: [20:00:00 24/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: CRT v1: 19 u1: BPM st: NotStopd t0: [20:00:00 24/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: CRT v1: 19 u1: BPM st: NotStopd t0: [20:00:00 24/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: CRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: CRT v1: 95 u1: % st: NotStopd t0: [20:00:00 24/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: CRT v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 24/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: CRT v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 24/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: CRT v1: SIMV+PS st: NotStopd t0: [20:00:00 24/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: CRT v1: 7 u1: # st: NotStopd t0: [20:00:00 24/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: CRT v1: Servo 900c st: NotStopd t0: [20:00:00 24/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: CRT v1: SQUARE st: NotStopd t0: [20:00:00 24/12/2015] id: Working Pressure el: 0 cu: CSRU cg: CRT v1: 65 u1: cmH2O st: NotStopd
t0: [20:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 24/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 24/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 120 u1: BPM st: NotStopd t0: [20:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [20:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [20:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 24/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:00:00 24/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [20:00:00 24/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [20:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [20:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 700 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 24/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [20:00:00 24/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 24/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 24/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [20:00:00 24/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [20:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd
t0: [20:03:00 24/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd t0: [20:03:00 24/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.7035 u1: ml/dl st: NotStopd t0: [20:03:00 24/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 102 rs: Final st: NotStopd t0: [20:03:00 24/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.6 rs: Final st: NotStopd t0: [20:03:00 24/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [20:03:00 24/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [20:03:00 24/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [20:03:00 24/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 142 u1: mmHg rs: Final st: NotStopd t0: [20:03:00 24/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd t0: [20:03:00 24/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 102 rs: Final st: NotStopd t0: [20:03:00 24/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.6 rs: Final st: NotStopd t0: [20:03:00 24/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [20:03:00 24/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: RN v1: 1.11 rs: Final st: NotStopd
t0: [21:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [21:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 7 vu: ml t0: [21:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [21:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 20 vu: ml t0: [21:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [21:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [19:54:00 24/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [19:54:00 24/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd
t0: [21:00:00 24/12/2015] id: INV Line#3 D/C Date el: 0 cu: CSRU cg: -1 st: D/C'd
tf: [03:00:00 25/12/2015] pt: IV Piggyback rt: IV fr: ASDIR m1: Heparin Sodium v1: 25000 u1: UNIT m2: D5W v2: 250 u2: ml
t0: [21:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 24/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [21:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 119 u1: BPM st: NotStopd t0: [21:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [21:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [21:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [21:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [21:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 700 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 24/12/2015] id: INV Line#2 D/C Date el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [12:00:00 24/12/2015] id: INV Line#3 D/C Date el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 24/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [20:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [20:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd
t0: [21:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [22:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 24/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 118 u1: BPM st: NotStopd t0: [22:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [22:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [22:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [22:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [22:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 7 vu: ml t0: [22:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [22:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 30 vu: ml t0: [22:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [22:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml t0: [22:00:00 24/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [22:00:00 24/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 57 vu: ml
t0: [22:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [22:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 700 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 24/12/2015] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 50 ap: none
t0: [23:00:00 24/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 24/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 24/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [23:00:00 24/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 24/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 24/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 24/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [23:00:00 24/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 116 u1: BPM st: NotStopd t0: [23:00:00 24/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 24/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 24/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [23:00:00 24/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [23:00:00 24/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [23:00:00 24/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [23:00:00 24/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [23:00:00 24/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [23:00:00 24/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 24/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [23:00:00 24/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [23:00:00 24/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 24/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [23:00:00 24/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 24/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [23:00:00 24/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 7 vu: ml t0: [23:00:00 24/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [23:00:00 24/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 30 vu: ml t0: [23:00:00 24/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [23:00:00 24/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [23:00:00 24/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 24/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 24/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [23:00:00 24/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 700 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 24/12/2015] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 30 cv: 230 ap: none
t0: [00:00:00 25/12/2015] id: INV Line#2 D/C Date el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [00:00:00 25/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: CRT v1: 11.5789 u1: ml/cmH st: NotStopd t0: [00:00:00 25/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 25/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: CRT v1: 50 u1: decFrc st: NotStopd t0: [00:00:00 25/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: CRT v1: 30 u1: decFrc st: NotStopd t0: [00:00:00 25/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 25/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: CRT v1: 25% st: NotStopd t0: [00:00:00 25/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 25/12/2015] id: Airway Size el: 0 cu: CSRU cg: CRT v1: 7.5 mm st: NotStopd t0: [00:00:00 25/12/2015] id: Airway Type el: 0 cu: CSRU cg: CRT v1: Endotracheal st: NotStopd t0: [00:00:00 25/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: CRT u1: Deg. C st: NotStopd t0: [00:00:00 25/12/2015] id: Intubation Date el: 0 cu: CSRU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 25/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: CRT v1: 4 st: NotStopd t0: [00:00:00 25/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: CRT v1: 12 u1: cmH2O st: NotStopd t0: [00:00:00 25/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: CRT v1: 8.8 u1: L/min st: NotStopd t0: [00:00:00 25/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: CRT v1: 8.3 u1: L/min st: NotStopd t0: [00:00:00 25/12/2015] id: PEEP Set el: 0 cu: CSRU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 25/12/2015] id: Pause Time % el: 0 cu: CSRU cg: CRT v1: 0% st: NotStopd t0: [00:00:00 25/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: CRT v1: 35.2 u1: lpm st: NotStopd t0: [00:00:00 25/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 43 u1: cmH2O st: NotStopd t0: [00:00:00 25/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: CRT v1: 38 u1: cmH2O st: NotStopd t0: [00:00:00 25/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: CRT v1: Yes st: NotStopd t0: [00:00:00 25/12/2015] id: Pressure Support el: 0 cu: CSRU cg: CRT v1: 5 u1: . st: NotStopd t0: [00:00:00 25/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: CRT v1: 0 u1: BPM st: NotStopd t0: [00:00:00 25/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: CRT v1: 19 u1: BPM st: NotStopd t0: [00:00:00 25/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: CRT v1: 19 u1: BPM st: NotStopd t0: [00:00:00 25/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: CRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: CRT v1: 100 u1: % st: NotStopd t0: [00:00:00 25/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: CRT v1: 448 u1: ml/B st: NotStopd t0: [00:00:00 25/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: CRT v1: 440 u1: ml/B st: NotStopd t0: [00:00:00 25/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: CRT v1: SIMV+PS st: NotStopd t0: [00:00:00 25/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: CRT v1: 7 u1: # st: NotStopd t0: [00:00:00 25/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: CRT v1: Servo 900c st: NotStopd t0: [00:00:00 25/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: CRT v1: SQUARE st: NotStopd t0: [00:00:00 25/12/2015] id: Working Pressure el: 0 cu: CSRU cg: CRT v1: 65 u1: cmH2O st: NotStopd
t0: [20:00:00 24/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 25/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 25/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 25/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 25/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 25/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 25/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 25/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [00:00:00 25/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 25/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 25/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 25/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 25/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 25/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 25/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 25/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [00:00:00 25/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 25/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 25/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [00:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 25/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 25/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 25/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 25/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [00:00:00 25/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [00:00:00 25/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 25/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 25/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 111 u1: BPM st: NotStopd t0: [00:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 25/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 25/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 25/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [00:00:00 25/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [00:00:00 25/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 25/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 25/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [00:00:00 25/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 25/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 25/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 25/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [00:00:00 25/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [00:00:00 25/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 25/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 25/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 25/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 25/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 25/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 25/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 25/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [00:00:00 25/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 25/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [00:00:00 25/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [00:00:00 25/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 25/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [00:00:00 25/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 25/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 25/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [00:00:00 25/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [00:00:00 25/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [00:00:00 25/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [00:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [00:00:00 25/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [00:00:00 25/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [00:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [00:00:00 25/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 25/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [00:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 25/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 25/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [00:00:00 25/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [00:00:00 25/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 25/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [00:00:00 25/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 25/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 25/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 25/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [00:00:00 25/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 25/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 25/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 25/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 25/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [00:00:00 25/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 25/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 25/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [00:00:00 25/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [00:00:00 25/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [00:00:00 25/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 25/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 25/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 25/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 25/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [00:00:00 25/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 25/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [00:00:00 25/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 25/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 25/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 25/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 25/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [00:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [00:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 7 vu: ml t0: [00:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [00:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 30 vu: ml t0: [00:00:00 25/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [00:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [00:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [00:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 700 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [01:00:00 25/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [01:00:00 25/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [01:00:00 25/12/2015] id: Airway Size el: 0 cu: CSRU cg: CRT v1: 7.5 mm st: NotStopd t0: [01:00:00 25/12/2015] id: Airway Type el: 0 cu: CSRU cg: CRT v1: Endotracheal st: NotStopd t0: [01:00:00 25/12/2015] id: Intubation Date el: 0 cu: CSRU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 25/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: CRT v1: 35 u1: cmH2O st: NotStopd t0: [01:00:00 25/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: CRT v1: Blood Tinged v2: Thin st: NotStopd t0: [01:00:00 25/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: CRT v1: Suctioned v2: Moderate st: NotStopd t0: [01:00:00 25/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: CRT v1: 7 u1: # st: NotStopd t0: [01:00:00 25/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: CRT v1: Servo 900c st: NotStopd
t0: [01:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [01:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 113 u1: BPM st: NotStopd t0: [01:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [01:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [01:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [01:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [01:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 7 vu: ml t0: [01:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [01:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 30 vu: ml t0: [01:00:00 25/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [01:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [01:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [01:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 700 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:46:00 24/12/2015] id: Vancomycin/Random Drug Level el: 0 cu: CSRU cg: 3161 v1: 21.7 rs: Final st: NotStopd
t0: [02:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 114 u1: BPM st: NotStopd t0: [02:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [02:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [02:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [02:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [02:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 7 vu: ml t0: [02:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [02:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 30 vu: ml t0: [02:00:00 25/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [02:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [02:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [02:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 700 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:29:00 25/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.31 rs: Final st: NotStopd t0: [02:29:00 25/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 98 rs: Final st: NotStopd t0: [02:29:00 25/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [02:29:00 25/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [02:29:00 25/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 47 u1: mmHg rs: Final st: NotStopd t0: [02:29:00 25/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 140 u1: mmHg rs: Final st: NotStopd t0: [02:29:00 25/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.31 rs: Final st: NotStopd t0: [02:29:00 25/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 98 rs: Final st: NotStopd t0: [02:29:00 25/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.19 rs: Final st: NotStopd t0: [02:29:00 25/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [02:13:00 25/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 17.2 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 17.2 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 32.7 u1: % rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.3 u1: gm/dl rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 392 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.58 u1: /mic l rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 17.2 rs: Final st: NotStopd t0: [02:29:00 25/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.96 u1: ml/dl st: NotStopd
t0: [02:13:00 25/12/2015] id: PT el: 0 cu: CSRU cg: 3161 v1: 16 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 41 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 16 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 41 rs: Final st: NotStopd
t0: [02:13:00 25/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 55 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 105 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 106 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.3 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 135 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 55 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 105 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 106 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.3 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [02:13:00 25/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 135 rs: Final st: NotStopd
t0: [03:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 114 u1: BPM st: NotStopd t0: [03:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [03:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [03:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [03:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 95 u1: % st: NotStopd t0: [03:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [03:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 7 vu: ml t0: [03:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [03:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 30 vu: ml t0: [03:00:00 25/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [03:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [03:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 25/12/2015] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 260 cv: 260 ap: none t0: [23:00:00 25/12/2015] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -126.689 cv: -126.689 ap: none t0: [23:00:00 25/12/2015] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 93.3112 cv: 2166.45 ap: none t0: [23:00:00 25/12/2015] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 133.311 cv: 3176.45 ap: none t0: [23:00:00 25/12/2015] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 910 ap: none t0: [23:00:00 25/12/2015] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 260 cv: 1925 ap: none t0: [23:00:00 25/12/2015] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -126.689 cv: 788.446 ap: none t0: [23:00:00 25/12/2015] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 260 cv: 2388 ap: none t0: [23:00:00 25/12/2015] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -126.689 cv: 10201.1 ap: carryForward
t0: [03:30:00 25/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: CRT v1: 12.2222 u1: ml/cmH st: NotStopd t0: [03:30:00 25/12/2015] id: RSBI Not Completed el: 0 cu: CSRU cg: CRT v1: No Spon Resp st: NotStopd t0: [03:30:00 25/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [03:30:00 25/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: CRT v1: 50 u1: decFrc st: NotStopd t0: [03:30:00 25/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: CRT v1: 30 u1: decFrc st: NotStopd t0: [03:30:00 25/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [03:30:00 25/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: CRT v1: 33% st: NotStopd t0: [03:30:00 25/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [03:30:00 25/12/2015] id: Airway Size el: 0 cu: CSRU cg: CRT v1: 7.5 mm st: NotStopd t0: [03:30:00 25/12/2015] id: Airway Type el: 0 cu: CSRU cg: CRT v1: Endotracheal st: NotStopd t0: [03:30:00 25/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: CRT u1: Deg. C st: NotStopd t0: [03:30:00 25/12/2015] id: Intubation Date el: 0 cu: CSRU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [03:30:00 25/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: CRT v1: 4 st: NotStopd t0: [03:30:00 25/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: CRT v1: 13.6 u1: cmH2O st: NotStopd t0: [03:30:00 25/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: CRT v1: 9.7 u1: L/min st: NotStopd t0: [03:30:00 25/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: CRT v1: 9.5 u1: L/min st: NotStopd t0: [03:30:00 25/12/2015] id: PEEP Set el: 0 cu: CSRU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [03:30:00 25/12/2015] id: Pause Time % el: 0 cu: CSRU cg: CRT v1: 0% st: NotStopd t0: [03:30:00 25/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: CRT v1: 29.3939 u1: lpm st: NotStopd t0: [03:30:00 25/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 41 u1: cmH2O st: NotStopd t0: [03:30:00 25/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: CRT v1: 38 u1: cmH2O st: NotStopd t0: [03:30:00 25/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: CRT v1: Yes st: NotStopd t0: [03:30:00 25/12/2015] id: Pressure Support el: 0 cu: CSRU cg: CRT v1: 5 u1: . st: NotStopd t0: [03:30:00 25/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: CRT v1: 0 u1: BPM st: NotStopd t0: [03:30:00 25/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: CRT v1: 22 u1: BPM st: NotStopd t0: [03:30:00 25/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: CRT v1: 22 u1: BPM st: NotStopd t0: [03:30:00 25/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: CRT v1: 2 u1: cmH2O st: NotStopd t0: [03:30:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: CRT v1: 98 u1: % st: NotStopd t0: [03:30:00 25/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: CRT v1: 431 u1: ml/B st: NotStopd t0: [03:30:00 25/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: CRT v1: 440 u1: ml/B st: NotStopd t0: [03:30:00 25/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: CRT v1: SIMV+PS st: NotStopd t0: [03:30:00 25/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: CRT v1: 7 u1: # st: NotStopd t0: [03:30:00 25/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: CRT v1: Servo 900c st: NotStopd t0: [03:30:00 25/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: CRT v1: RAMP st: NotStopd t0: [03:30:00 25/12/2015] id: Working Pressure el: 0 cu: CSRU cg: CRT v1: 65 u1: cmH2O st: NotStopd
tf: [20:00:00 25/12/2015] pt: IV Piggyback rt: IV fr: ASDIR m1: Heparin Sodium v1: 25000 u1: UNIT m2: D5W v2: 250 u2: ml
t0: [00:00:00 25/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [00:00:00 25/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 25/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [04:00:00 25/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [04:00:00 25/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 25/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 25/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 116 u1: BPM st: NotStopd t0: [04:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [04:00:00 25/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [04:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [04:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [04:00:00 25/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 25/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [04:00:00 25/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [04:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [04:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 8 vu: ml t0: [04:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [04:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 30 vu: ml t0: [04:00:00 25/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [04:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [04:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:00:00 25/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 25/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [04:00:00 25/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [04:00:00 25/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 25/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 25/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [04:00:00 25/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 25/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 25/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [04:00:00 25/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [04:00:00 25/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd
t0: [03:00:00 25/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [03:00:00 25/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 25/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 25/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [03:00:00 25/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [03:00:00 25/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [03:00:00 25/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [04:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [05:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 25/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 25/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 116 u1: BPM st: NotStopd t0: [05:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 25/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 25/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [05:00:00 25/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [05:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [05:00:00 25/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [05:00:00 25/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 25/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [05:00:00 25/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [05:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [05:00:00 25/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 25/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 25/12/2015] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.15792 u1: m2 st: NotStopd t0: [05:00:00 25/12/2015] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.35322 u1: m2 st: NotStopd t0: [05:00:00 25/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 25/12/2015] id: Weight Change el: 0 cu: CSRU cg: RN v1: 0 u1: kg st: NotStopd t0: [05:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 25/12/2015] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd
t0: [05:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [05:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 8 vu: ml t0: [05:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [05:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [05:00:00 25/12/2015] id: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CSRU cg: RN ai: 338 vo: 30.9375 vu: ml t0: [05:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [05:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [05:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [05:26:00 25/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.29 rs: Final st: NotStopd t0: [05:26:00 25/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.9476 u1: ml/dl st: NotStopd t0: [05:26:00 25/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [05:26:00 25/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -4 rs: Final st: NotStopd t0: [05:26:00 25/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [05:26:00 25/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 46 u1: mmHg rs: Final st: NotStopd t0: [05:26:00 25/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 136 u1: mmHg rs: Final st: NotStopd t0: [05:26:00 25/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.29 rs: Final st: NotStopd t0: [05:26:00 25/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [05:26:00 25/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd t0: [05:26:00 25/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [06:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [06:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 8 vu: ml t0: [06:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [06:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [06:00:00 25/12/2015] tf: [09:53:00 12/01/2016] dt: 26153 id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 30.9375 vu: ml t0: [06:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [04:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [05:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 116 u1: BPM st: NotStopd t0: [06:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [06:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [06:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [06:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [06:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [06:00:00 25/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 30 vu: ml t0: [06:00:00 25/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 13 vu: ml
t0: [06:30:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:30:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:30:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [06:30:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:30:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 157 u1: BPM st: NotStopd t0: [06:30:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [06:30:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [06:30:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [06:30:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:30:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [06:30:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:30:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:30:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:30:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:30:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [06:30:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [06:30:00 25/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: CRT v1: 11.2821 u1: ml/cmH st: NotStopd t0: [06:30:00 25/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: CRT v1: 23cm v2: Lip st: NotStopd t0: [06:30:00 25/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: CRT v1: 50 u1: decFrc st: NotStopd t0: [06:30:00 25/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: CRT v1: 30 u1: decFrc st: NotStopd t0: [06:30:00 25/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [06:30:00 25/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: CRT v1: 33% st: NotStopd t0: [06:30:00 25/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [06:30:00 25/12/2015] id: Airway Size el: 0 cu: CSRU cg: CRT v1: 7.5 mm st: NotStopd t0: [06:30:00 25/12/2015] id: Airway Type el: 0 cu: CSRU cg: CRT v1: Endotracheal st: NotStopd t0: [06:30:00 25/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: CRT u1: Deg. C st: NotStopd t0: [06:30:00 25/12/2015] id: Intubation Date el: 0 cu: CSRU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [06:30:00 25/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: CRT v1: 4 st: NotStopd t0: [06:30:00 25/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: CRT v1: 14.6 u1: cmH2O st: NotStopd t0: [06:30:00 25/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: CRT v1: 11.4 u1: L/min st: NotStopd t0: [06:30:00 25/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: CRT v1: 11.2 u1: L/min st: NotStopd t0: [06:30:00 25/12/2015] id: PEEP Set el: 0 cu: CSRU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [06:30:00 25/12/2015] id: Pause Time % el: 0 cu: CSRU cg: CRT v1: 0% st: NotStopd t0: [06:30:00 25/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: CRT v1: 34.5455 u1: lpm st: NotStopd t0: [06:30:00 25/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: CRT v1: 44 u1: cmH2O st: NotStopd t0: [06:30:00 25/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: CRT v1: 41 u1: cmH2O st: NotStopd t0: [06:30:00 25/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: CRT v1: Yes st: NotStopd t0: [06:30:00 25/12/2015] id: Pressure Support el: 0 cu: CSRU cg: CRT v1: 5 u1: . st: NotStopd t0: [06:30:00 25/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: CRT v1: 0 u1: BPM st: NotStopd t0: [06:30:00 25/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: CRT v1: 26 u1: BPM st: NotStopd t0: [06:30:00 25/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: CRT v1: 26 u1: BPM st: NotStopd t0: [06:30:00 25/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: CRT v1: 2 u1: cmH2O st: NotStopd t0: [06:30:00 25/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: CRT v1: 440 u1: ml/B st: NotStopd t0: [06:30:00 25/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: CRT v1: 440 u1: ml/B st: NotStopd t0: [06:30:00 25/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: CRT v1: SIMV+PS st: NotStopd t0: [06:30:00 25/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: CRT v1: 7 u1: # st: NotStopd t0: [06:30:00 25/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: CRT v1: Servo 900c st: NotStopd t0: [06:30:00 25/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: CRT v1: SQUARE st: NotStopd t0: [06:30:00 25/12/2015] id: Working Pressure el: 0 cu: CSRU cg: CRT v1: 65 u1: cmH2O st: NotStopd
t0: [06:30:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:30:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [06:35:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:35:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:35:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:35:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 126 u1: BPM st: NotStopd t0: [06:35:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [06:35:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg v2: 43 u2: mmHg st: NotStopd t0: [06:35:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 52 u1: mmHg st: NotStopd t0: [06:35:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:35:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [06:35:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [06:35:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:40:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:40:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:40:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:40:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 112 u1: BPM st: NotStopd t0: [06:40:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [06:40:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [06:40:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [06:40:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:40:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [06:40:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 6 u1: BPM st: NotStopd t0: [06:40:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [06:40:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:45:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:45:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:45:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:45:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:45:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 110 u1: BPM st: NotStopd t0: [06:45:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [06:45:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [06:45:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [06:45:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:45:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [06:45:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [06:45:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [06:45:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:35:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:35:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:35:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [06:35:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip t0: [06:40:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:40:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:40:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 20 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [06:40:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip t0: [06:45:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:45:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.35 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:45:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 15 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [06:45:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [07:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 122 u1: BPM st: NotStopd t0: [07:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [07:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [07:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [07:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [07:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [07:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 94 u1: % st: NotStopd t0: [07:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:10:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:10:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:10:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:10:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:10:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 94 u1: BPM st: NotStopd t0: [07:10:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:10:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [07:10:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [07:10:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:10:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [07:10:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [07:10:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [07:10:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.35 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [07:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip t0: [07:10:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:10:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.35 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:10:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [07:10:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 25/12/2015] id: KneeImmobilizer/Loc el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [08:00:00 25/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 25/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 25/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 25/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 25/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 25/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 25/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 25/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 25/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 25/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [08:00:00 25/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 25/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 25/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 25/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 25/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 25/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [08:00:00 25/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 25/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [08:00:00 25/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 25/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 25/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 25/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 25/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [08:00:00 25/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [08:00:00 25/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 25/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 25/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 25/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 103 u1: BPM st: NotStopd t0: [08:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 25/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 25/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 25/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [08:00:00 25/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [08:00:00 25/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 25/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 25/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 25/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 25/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [08:00:00 25/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 25/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [08:00:00 25/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [08:00:00 25/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 25/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 25/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [08:00:00 25/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 25/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 25/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 25/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 25/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 25/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [08:00:00 25/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 25/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [08:00:00 25/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 25/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 25/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [08:00:00 25/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 25/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 25/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [08:00:00 25/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [08:00:00 25/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [08:00:00 25/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [08:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [08:00:00 25/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [08:00:00 25/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [08:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [08:00:00 25/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 25/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 25/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 25/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [08:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [08:00:00 25/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [08:00:00 25/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [08:00:00 25/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [08:00:00 25/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 25/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [08:00:00 25/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 25/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 25/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [08:00:00 25/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 25/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 25/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 25/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 25/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 25/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [08:00:00 25/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [08:00:00 25/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [08:00:00 25/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 25/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 25/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 25/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 25/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 25/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 25/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 25/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 25/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 25/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 25/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [08:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 10 vu: ml t0: [08:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 16 vu: ml t0: [08:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 19.305 vu: ml t0: [08:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml t0: [08:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 78.375 vu: ml t0: [08:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 7 vu: ml
t0: [08:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.33 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [08:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [09:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [09:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [09:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [09:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [09:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [09:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 8 vu: ml t0: [09:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [09:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [09:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 40.8375 vu: ml t0: [09:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml
t0: [09:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.31 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [09:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:52:00 25/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.34 rs: Final st: NotStopd t0: [08:52:00 25/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [08:52:00 25/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [08:52:00 25/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 42 u1: mmHg rs: Final st: NotStopd t0: [08:52:00 25/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 141 u1: mmHg rs: Final st: NotStopd t0: [08:52:00 25/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.34 rs: Final st: NotStopd
t0: [08:52:00 25/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.9631 u1: ml/dl st: NotStopd t0: [08:52:00 25/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
tf: [12:00:00 29/12/2015] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Furosemide v1: 100 u1: mg m2: D5W v2: 25 u2: ml
id: Levophed-k el: 103 cu: CSRU cg: RN io: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions am: 16 du: mcgkgmin rt: IV Drip id: Lasix el: 100 cu: CSRU cg: RN io: D5W 25.0ml + 100mghr Lasix IV Infusions am: 100 du: mghr rt: IV Drip
io: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ra: 19.1813 ru: ml/hr io: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ra: 1 ru: ml/hr
t0: [10:00:00 25/12/2015] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CSRU cg: -1 ai: 153 vo: 0 st: D/C'd
tf: [15:00:00 05/01/2016] pt: Unit Dose rt: PR fr: QD fs: 10 dn: 1 m1: Bisacodyl (Rectal) v1: 10 u1: mg tf: [12:00:00 11/01/2016] pt: Unit Dose rt: NG fr: QD fs: 10 dn: 1 m1: Multivitamins v1: 5 u1: ml
id: D5W el: 1 cu: CSRU cg: RN io: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions vo: 250 du: ml rt: Intravenous Push id: D5W el: 1 cu: CSRU cg: RN io: D5W 25.0ml + 100mghr Lasix IV Infusions vo: 25 du: ml rt: Intravenous Push id: TF Residual el: 1 cu: CSRU cg: RN io: TF Residual Gastric/TF Residual du: ml rt: Gastric/Feeding Tube
t0: [08:00:00 25/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 25/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 25/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 25/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [08:00:00 25/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [10:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 25/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [10:00:00 25/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 103 u1: BPM st: NotStopd t0: [10:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 25/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 25/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [10:00:00 25/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [10:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [10:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [10:00:00 25/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 25/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [10:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [10:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [10:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 25/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [10:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [10:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 8 vu: ml t0: [10:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [10:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [10:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 38.3625 vu: ml t0: [10:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml t0: [10:00:00 25/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 30 vu: ml t0: [10:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0 vu: ml t0: [10:00:00 25/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 10 vu: ml
t0: [10:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 25/12/2015] tf: [20:00:00 26/12/2015] dt: 2040 id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.31 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 25 su: ml rt: IV Drip t0: [10:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [10:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [10:00:00 25/12/2015] tf: [04:00:00 27/12/2015] dt: 2520 id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 90 vu: ml
t0: [11:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 104 u1: BPM st: NotStopd t0: [11:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [11:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [11:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [11:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [11:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [11:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 8 vu: ml t0: [11:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [11:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [11:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 19.1813 vu: ml t0: [11:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml t0: [11:00:00 25/12/2015] tf: [20:00:00 26/12/2015] dt: 1980 id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1 vu: ml
t0: [11:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 25 su: ml rt: IV Drip t0: [11:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [11:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.28 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [11:36:00 25/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.4 rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: no data rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: no data rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 u1: mmHg rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 u1: mmHg rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.4 rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.14 rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd
tf: [22:00:00 25/12/2015] pt: IV Piggyback rt: IV fr: Q24H fs: 12 dn: 1 m1: Vancomycin HCl v1: 1000 u1: mg m2: Iso-Osmotic Dextrose v2: 200 u2: ml tf: [08:00:00 29/12/2015] pt: IV Piggyback rt: IV fr: Q24H fs: 12 dn: 1 m1: Vancomycin HCl v1: 1000 u1: mg m2: D5W v2: 100 u2: ml
t0: [12:00:00 25/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Changed st: NotStopd t0: [12:00:00 25/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 25/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 25/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 25/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [12:00:00 25/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [12:00:00 25/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Changed st: NotStopd t0: [12:00:00 25/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 25/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 25/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [12:00:00 25/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 25/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 25/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 25/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 25/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 25/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [12:00:00 25/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 25/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [12:00:00 25/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 25/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 25/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 25/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 25/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [12:00:00 25/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [12:00:00 25/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 25/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 25/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 25/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 25/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [12:00:00 25/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 25/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 103 u1: BPM st: NotStopd t0: [12:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:00:00 25/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 25/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [12:00:00 25/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [12:00:00 25/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [12:00:00 25/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 25/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [12:00:00 25/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 25/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [12:00:00 25/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [12:00:00 25/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [12:00:00 25/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 25/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 25/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [12:00:00 25/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 25/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [12:00:00 25/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [12:00:00 25/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 25/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 25/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [12:00:00 25/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 25/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [12:00:00 25/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 25/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 25/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [12:00:00 25/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 25/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 25/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [12:00:00 25/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [12:00:00 25/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [12:00:00 25/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [12:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg v2: 42 u2: mmHg st: NotStopd t0: [12:00:00 25/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [12:00:00 25/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [12:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [12:00:00 25/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 25/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 25/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 25/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [12:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [12:00:00 25/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [12:00:00 25/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [12:00:00 25/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [12:00:00 25/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 25/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [12:00:00 25/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 25/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 25/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 9 u1: BPM st: NotStopd t0: [12:00:00 25/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 25/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 25/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [12:00:00 25/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 94 u1: % st: NotStopd t0: [12:00:00 25/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 25/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [12:00:00 25/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [12:00:00 25/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [12:00:00 25/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 25/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 25/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 25/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [12:00:00 25/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 25/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [12:00:00 25/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Changed st: NotStopd t0: [12:00:00 25/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 25/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 25/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 25/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [12:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [12:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 8 vu: ml t0: [12:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [12:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [12:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 17.325 vu: ml t0: [12:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml t0: [12:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1 vu: ml
t0: [12:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.26 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 25 su: ml rt: IV Drip t0: [12:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [12:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 800 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:36:00 25/12/2015] id: PT el: 0 cu: CSRU cg: 3161 v1: 15.2 rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 47 rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 15.2 rs: Final st: NotStopd t0: [11:36:00 25/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 47 rs: Final st: NotStopd
t0: [13:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 104 u1: BPM st: NotStopd t0: [13:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [13:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [13:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [13:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [13:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [13:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 8 vu: ml t0: [13:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [13:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [13:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 16.0875 vu: ml t0: [13:00:00 25/12/2015] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 3.5 vu: ml t0: [13:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.5 vu: ml
t0: [13:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.24 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 25 su: ml rt: IV Drip t0: [13:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [13:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:07:00 25/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 11.5789 u1: ml/cmH st: NotStopd t0: [13:07:00 25/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [13:07:00 25/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: RRT v1: 50 u1: decFrc st: NotStopd t0: [13:07:00 25/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: RRT v1: 30 u1: decFrc st: NotStopd t0: [13:07:00 25/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [13:07:00 25/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: RRT v1: 33% st: NotStopd t0: [13:07:00 25/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 60 u1: cmH2O st: NotStopd t0: [13:07:00 25/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:07:00 25/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [13:07:00 25/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT u1: Deg. C st: NotStopd t0: [13:07:00 25/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [13:07:00 25/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4 st: NotStopd t0: [13:07:00 25/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [13:07:00 25/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: RRT v1: 13.2 u1: L/min st: NotStopd t0: [13:07:00 25/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.1 u1: L/min st: NotStopd t0: [13:07:00 25/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:07:00 25/12/2015] id: Pause Time % el: 0 cu: CSRU cg: RRT v1: 0% st: NotStopd t0: [13:07:00 25/12/2015] id: Peak Flow (Calc) el: 0 cu: CSRU cg: RRT v1: 40 u1: lpm st: NotStopd t0: [13:07:00 25/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 43 u1: cmH2O st: NotStopd t0: [13:07:00 25/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [13:07:00 25/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: RRT v1: Yes st: NotStopd t0: [13:07:00 25/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [13:07:00 25/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [13:07:00 25/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [13:07:00 25/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [13:07:00 25/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [13:07:00 25/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [13:07:00 25/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [13:07:00 25/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 427 u1: ml/B st: NotStopd t0: [13:07:00 25/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [13:07:00 25/12/2015] id: Total PEEP Level el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:07:00 25/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [13:07:00 25/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: RRT v1: 7 u1: # st: NotStopd t0: [13:07:00 25/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Servo 900c st: NotStopd t0: [13:07:00 25/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd t0: [13:07:00 25/12/2015] id: Working Pressure el: 0 cu: CSRU cg: RRT v1: 65 u1: cmH2O st: NotStopd
t0: [13:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [14:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 104 u1: BPM st: NotStopd t0: [14:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 104 u1: mmHg v2: 43 u2: mmHg st: NotStopd t0: [14:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [14:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [14:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [14:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [14:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [14:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [14:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 14.85 vu: ml t0: [14:00:00 25/12/2015] tf: [15:00:00 27/12/2015] dt: 2940 id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 3.5 vu: ml t0: [14:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2 vu: ml
t0: [14:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.22 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 25 su: ml rt: IV Drip t0: [14:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [14:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [14:00:00 25/12/2015] id: FIO2 Alarm-High el: 0 cu: CSRU cg: -1 st: D/C'd t0: [14:00:00 25/12/2015] id: FIO2 Alarm-Low el: 0 cu: CSRU cg: -1 st: D/C'd t0: [14:00:00 25/12/2015] id: % Inspir. Time el: 0 cu: CSRU cg: -1 st: D/C'd t0: [14:00:00 25/12/2015] id: Pause Time % el: 0 cu: CSRU cg: -1 st: D/C'd t0: [14:00:00 25/12/2015] id: Plateau-Off el: 0 cu: CSRU cg: -1 st: D/C'd t0: [14:00:00 25/12/2015] id: Ventilator No. el: 0 cu: CSRU cg: -1 st: D/C'd t0: [14:00:00 25/12/2015] id: Working Pressure el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [14:00:00 25/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [14:00:00 25/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [14:30:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:30:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:30:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:30:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [14:30:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [14:30:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [14:30:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:30:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [14:30:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [14:30:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 91 u1: % st: NotStopd t0: [14:30:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [15:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [15:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [15:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 25/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [15:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [15:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [15:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [15:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [15:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [15:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [15:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 14.2312 vu: ml t0: [15:00:00 25/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 3.5 vu: ml t0: [15:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2 vu: ml
t0: [14:30:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:30:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.24 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:30:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 25 su: ml rt: IV Drip t0: [14:30:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [14:30:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [15:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.24 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [15:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [15:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [15:00:00 25/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 20 vu: ml t0: [15:00:00 25/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 40 vu: ml
t0: [14:00:00 25/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 25/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 25/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [14:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 25/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 25/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [14:00:00 25/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 25/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 25/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 25/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 25/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 25/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 25/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [16:00:00 25/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 25/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 25/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 25/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [16:00:00 25/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 25/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 25/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 25/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 25/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 25/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [16:00:00 25/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 25/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [16:00:00 25/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 25/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 25/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 25/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 25/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [16:00:00 25/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [16:00:00 25/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 25/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 25/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 25/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [16:00:00 25/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 25/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [16:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 25/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 25/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [16:00:00 25/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [16:00:00 25/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [16:00:00 25/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 25/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [16:00:00 25/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 25/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [16:00:00 25/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [16:00:00 25/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [16:00:00 25/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 25/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 25/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [16:00:00 25/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 25/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 25/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 25/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 25/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 25/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [16:00:00 25/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 25/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [16:00:00 25/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [16:00:00 25/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 25/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [16:00:00 25/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 25/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 25/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [16:00:00 25/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [16:00:00 25/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [16:00:00 25/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [16:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 42 u2: mmHg st: NotStopd t0: [16:00:00 25/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [16:00:00 25/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [16:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [16:00:00 25/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 25/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 25/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [16:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [16:00:00 25/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [16:00:00 25/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [16:00:00 25/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [16:00:00 25/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 25/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [16:00:00 25/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [16:00:00 25/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 25/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [16:00:00 25/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 25/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 25/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [16:00:00 25/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 25/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [16:00:00 25/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 25/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [16:00:00 25/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [16:00:00 25/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 25/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 25/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 25/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 25/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 25/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [16:00:00 25/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 25/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [16:00:00 25/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 25/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 25/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 25/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 25/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [16:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [16:00:00 25/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 80 vu: ml t0: [16:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [16:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [16:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [16:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 14.85 vu: ml t0: [16:00:00 25/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 3.5 vu: ml t0: [16:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml
t0: [16:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [16:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [16:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [19:00:00 26/12/2015] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Amiodarone HCl v1: 400 u1: mg
t0: [16:38:00 25/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [16:38:00 25/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [16:38:00 25/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [16:38:00 25/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 33 u1: mmHg rs: Final st: NotStopd t0: [16:38:00 25/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 148 u1: mmHg rs: Final st: NotStopd t0: [16:38:00 25/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd
t0: [16:38:00 25/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.9848 u1: ml/dl st: NotStopd t0: [16:38:00 25/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [17:00:00 25/12/2015] id: Minute Volume (Set) el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [17:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 108 u1: BPM st: NotStopd t0: [17:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg v2: 43 u2: mmHg st: NotStopd t0: [17:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [17:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [17:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [17:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [17:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [17:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [17:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 12.375 vu: ml t0: [17:00:00 25/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 3.5 vu: ml t0: [17:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml
t0: [17:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.22 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [17:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [17:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:23:00 25/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.6667 u1: ml/cmH st: NotStopd t0: [17:23:00 25/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [17:23:00 25/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [17:23:00 25/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:23:00 25/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [17:23:00 25/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:23:00 25/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [17:23:00 25/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [17:23:00 25/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:23:00 25/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [17:23:00 25/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [17:23:00 25/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 12.1 u1: L/min st: NotStopd t0: [17:23:00 25/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:23:00 25/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [17:23:00 25/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [17:23:00 25/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [17:23:00 25/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [17:23:00 25/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [17:23:00 25/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [17:23:00 25/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [17:23:00 25/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [17:23:00 25/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [17:23:00 25/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [17:23:00 25/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 465 u1: ml/B st: NotStopd t0: [17:23:00 25/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [17:23:00 25/12/2015] id: Total PEEP Level el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:23:00 25/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [17:23:00 25/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [17:23:00 25/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [16:36:00 25/12/2015] id: PT el: 0 cu: CSRU cg: 3161 v1: 15.3 rs: Final st: NotStopd t0: [16:36:00 25/12/2015] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [16:36:00 25/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 52.5 rs: Final st: NotStopd t0: [16:36:00 25/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [16:36:00 25/12/2015] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 15.3 rs: Final st: NotStopd t0: [16:36:00 25/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 52.5 rs: Final st: NotStopd
t0: [18:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 109 u1: BPM st: NotStopd t0: [18:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [18:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [18:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [18:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [18:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [18:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [18:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [18:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 13.6125 vu: ml t0: [18:00:00 25/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 3.5 vu: ml t0: [18:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml
t0: [18:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.24 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [18:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [18:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
id: Fentanyl el: 101 cu: CSRU cg: RN io: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions am: 2500 du: mcghr rt: IV Drip
io: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ra: 0.7 ru: ml/hr
id: .9% Normal Saline el: 1 cu: CSRU cg: RN io: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions vo: 50 du: ml rt: Intravenous Push
t0: [16:38:00 25/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 4.1 rs: Final st: NotStopd t0: [16:38:00 25/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: RN v1: 1.08 rs: Final st: NotStopd t0: [16:38:00 25/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 4.1 rs: Final st: NotStopd t0: [17:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [18:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [19:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 112 u1: BPM st: NotStopd t0: [19:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [19:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [19:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [19:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [19:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [19:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [19:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [19:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [19:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 14.85 vu: ml t0: [19:00:00 25/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [19:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml
t0: [19:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.24 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [19:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [19:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 25/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 109 rs: Manual st: NotStopd t0: [12:00:00 25/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: RN v1: 109 rs: Manual st: NotStopd t0: [17:00:00 25/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 102 rs: Manual st: NotStopd t0: [17:00:00 25/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: RN v1: 102 rs: Manual st: NotStopd
t0: [18:00:00 25/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [18:00:00 25/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 25/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [18:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 25/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [18:00:00 25/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 25/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [18:00:00 25/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 25/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 25/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [20:00:00 25/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [20:00:00 25/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 25/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 25/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 25/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 25/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 25/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [20:00:00 25/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [20:00:00 25/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 25/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [20:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd
t0: [17:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN u1: % st: NotStopd t0: [18:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN u1: % st: NotStopd t0: [19:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN u1: % st: NotStopd t0: [20:00:00 25/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 25/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 25/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 25/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 25/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 25/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 25/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 25/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 25/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 25/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 25/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 25/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 25/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 25/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 25/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [20:00:00 25/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [20:00:00 25/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 25/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 25/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 25/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 25/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 25/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [20:00:00 25/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 25/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 25/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 25/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 25/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 25/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 108 u1: BPM st: NotStopd t0: [20:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 25/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 25/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [20:00:00 25/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 25/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 25/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 25/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 25/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 25/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 25/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 25/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 25/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 25/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [20:00:00 25/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 25/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 25/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 25/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 25/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [20:00:00 25/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [20:00:00 25/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [20:00:00 25/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [20:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [20:00:00 25/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [20:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [20:00:00 25/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 25/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [20:00:00 25/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 25/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [20:00:00 25/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 25/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 25/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Cool v2: Dusky st: NotStopd t0: [20:00:00 25/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [20:00:00 25/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 25/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 25/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 25/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 25/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 25/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [20:00:00 25/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 25/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [20:00:00 25/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 25/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 25/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [20:00:00 25/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 25/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 25/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [20:00:00 25/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 25/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 25/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 25/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 25/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 25/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 11 u1: number st: NotStopd t0: [20:00:00 25/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Comp. Limited st: NotStopd t0: [20:00:00 25/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 25/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [20:00:00 25/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 25/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 25/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 25/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 25/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [20:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.24 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [20:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [20:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 25/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 25/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 25/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:00:00 25/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.7778 u1: Deg. C st: NotStopd t0: [20:00:00 25/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 100 u1: Deg. F st: NotStopd
t0: [20:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [20:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [20:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [20:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [20:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 14.85 vu: ml t0: [20:00:00 25/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [20:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml
t0: [20:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd
t0: [20:00:00 25/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [20:00:00 25/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [20:00:00 25/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 25/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 25/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 25/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 25/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 25/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 25/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 25/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [20:00:00 25/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [20:00:00 25/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.4 u1: L/min st: NotStopd t0: [20:00:00 25/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 25/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 25/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [20:00:00 25/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [20:00:00 25/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:00:00 25/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [20:00:00 25/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [20:00:00 25/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [20:00:00 25/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 25/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Clear st: NotStopd t0: [20:00:00 25/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [20:00:00 25/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 447 u1: ml/B st: NotStopd t0: [20:00:00 25/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 25/12/2015] id: Total PEEP Level el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 25/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [20:00:00 25/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 25/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 25/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 120 vu: ml t0: [21:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [21:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [21:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [21:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [21:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 14.85 vu: ml t0: [21:00:00 25/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [21:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml
t0: [23:00:00 25/12/2015] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 100 ap: none
t0: [20:53:00 25/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [20:53:00 25/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.1476 u1: ml/dl st: NotStopd t0: [20:53:00 25/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 115 rs: Final st: NotStopd t0: [20:53:00 25/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -1 rs: Final st: NotStopd t0: [20:53:00 25/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 22 rs: Final st: NotStopd t0: [20:53:00 25/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 32 u1: mmHg rs: Final st: NotStopd t0: [20:53:00 25/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 156 u1: mmHg rs: Final st: NotStopd t0: [20:53:00 25/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [20:53:00 25/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 115 rs: Final st: NotStopd t0: [20:53:00 25/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.15 rs: Final st: NotStopd t0: [20:53:00 25/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 99 u1: % rs: Final st: NotStopd
t0: [20:53:00 25/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 3.5 rs: Final st: NotStopd t0: [20:53:00 25/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 3.5 rs: Final st: NotStopd t0: [21:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [21:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 109 u1: BPM st: NotStopd t0: [21:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [21:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [21:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [21:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [21:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [21:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.24 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [21:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [21:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:30:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:30:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:30:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:30:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:30:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:30:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:30:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 110 u1: BPM st: NotStopd t0: [20:30:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:30:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [20:30:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [20:30:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:30:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [20:30:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 37 u1: BPM st: NotStopd t0: [20:30:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [20:30:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:30:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:30:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.24 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:30:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [20:30:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [20:30:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [07:00:00 28/12/2015] pt: IV Piggyback rt: IV fr: ASDIR m1: Heparin Sodium v1: 25000 u1: UNIT m2: D5W v2: 250 u2: ml
t0: [22:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [22:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [22:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [22:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [22:00:00 25/12/2015] id: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 14.85 vu: ml t0: [22:00:00 25/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [22:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml
t0: [22:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 110 u1: BPM st: NotStopd t0: [22:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 104 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [22:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [22:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [22:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [22:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [22:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.23 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [22:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [22:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
id: KCL el: 100 cu: CSRU cg: RN io: D5W 50.0ml IV Infusions am: 20 du: mEq rt: Intravenous Push
tf: [10:00:00 13/02/2016] pt: Unit Dose rt: NG fr: BID fs: 10, 22 dn: 2 m1: Docusate Sodium (Liquid) v1: 100 u1: mg
id: D5W el: 1 cu: CSRU cg: RN io: D5W 50.0ml IV Infusions vo: 50 du: ml rt: Intravenous Push
t0: [22:00:00 25/12/2015] tf: [09:53:00 12/01/2016] dt: 25193 id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [22:00:00 25/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [22:00:00 25/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 25 vu: ml
t0: [23:00:00 25/12/2015] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 283 ap: none
t0: [22:00:00 25/12/2015] tf: [07:00:00 07/01/2016] dt: 17820 id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 180 vu: ml
t0: [23:00:00 25/12/2015] dt: 24 id: Drain #1 Total Out el: 3 cu: CSRU cg: RN cv: 180 ap: none
t0: [20:00:00 25/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 25/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 25/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [20:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 25/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [20:00:00 25/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [20:00:00 25/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 25/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [23:00:00 25/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [23:00:00 25/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 25/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [23:00:00 25/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [23:00:00 25/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [23:00:00 25/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [23:00:00 25/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [23:00:00 25/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd
t0: [23:00:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [23:00:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 107 u1: BPM st: NotStopd t0: [23:00:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:00:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [23:00:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [23:00:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [23:00:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [23:00:00 25/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 94 u1: % st: NotStopd t0: [23:00:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 25/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [23:00:00 25/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [23:00:00 25/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [23:00:00 25/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [23:00:00 25/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [23:00:00 25/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [23:00:00 25/12/2015] tf: [04:00:00 27/12/2015] dt: 1740 id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 14.2313 vu: ml
t0: [23:00:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.23 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [23:00:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [23:00:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 25/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Bloody v2: Thick st: NotStopd t0: [23:00:00 25/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [23:00:00 25/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml
t0: [20:00:00 25/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [23:00:00 25/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [23:00:00 25/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [23:15:00 25/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:15:00 25/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:15:00 25/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [23:15:00 25/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:15:00 25/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:15:00 25/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:15:00 25/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 107 u1: BPM st: NotStopd t0: [23:15:00 25/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [23:15:00 25/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [23:15:00 25/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [23:15:00 25/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:15:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [23:15:00 25/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [23:15:00 25/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 26/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 26/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 26/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 26/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 26/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 26/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 26/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [00:00:00 26/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 26/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 26/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 26/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 26/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 26/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 26/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 26/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: RN v1: Absent v2: Absent st: NotStopd t0: [00:00:00 26/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 26/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 26/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 26/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 26/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 26/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 26/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 26/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [00:00:00 26/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [00:00:00 26/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 26/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 26/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 26/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 108 u1: BPM st: NotStopd t0: [00:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [00:00:00 26/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 26/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 26/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [00:00:00 26/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [00:00:00 26/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 26/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 26/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [00:00:00 26/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 26/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [00:00:00 26/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 26/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [00:00:00 26/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [00:00:00 26/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 26/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 26/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 26/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 26/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 26/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 26/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 26/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 26/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [00:00:00 26/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 26/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [00:00:00 26/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 26/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 26/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [00:00:00 26/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [00:00:00 26/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [00:00:00 26/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [00:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [00:00:00 26/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [00:00:00 26/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [00:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [00:00:00 26/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 26/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [00:00:00 26/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 26/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [00:00:00 26/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 26/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 26/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 26/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 26/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [00:00:00 26/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 26/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 26/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [00:00:00 26/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 26/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 26/12/2015] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Clear v2: Mucoid st: NotStopd t0: [00:00:00 26/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 26/12/2015] id: Stool Management el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 26/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 26/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [00:00:00 26/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.5 u1: Deg. C st: NotStopd t0: [00:00:00 26/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 99.5 u1: Deg. F st: NotStopd t0: [00:00:00 26/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 26/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 26/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [00:00:00 26/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 26/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 26/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 26/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 26/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 26/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 11 u1: number st: NotStopd t0: [00:00:00 26/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Comp. Limited st: NotStopd t0: [00:00:00 26/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 26/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [00:00:00 26/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 26/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 26/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 26/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 26/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [00:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [00:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [00:00:00 26/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [00:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [00:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [00:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [00:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 13.7672 vu: ml
t0: [23:15:00 25/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:15:00 25/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.22 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:15:00 25/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [23:15:00 25/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [23:15:00 25/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [00:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [00:00:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [00:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:08:00 25/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 115 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: Total Bili Chemistry el: 0 cu: CSRU cg: 3161 v1: 0.5 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: ALT Enzymes el: 0 cu: CSRU cg: 3161 v1: 7 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: AST Enzymes el: 0 cu: CSRU cg: 3161 v1: 19 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: Alk. Phosphate Enzymes el: 0 cu: CSRU cg: 3161 v1: 149 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 115 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: LDH Enzymes el: 0 cu: CSRU cg: 3161 v1: 175 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: Total Bili (0-1.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 0.5 rs: Final st: NotStopd
t0: [00:00:00 26/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.1935 u1: ml/cmH st: NotStopd t0: [00:00:00 26/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [00:00:00 26/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 26/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 26/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 26/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 26/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 26/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 26/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 26/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [00:00:00 26/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [00:00:00 26/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.7 u1: L/min st: NotStopd t0: [00:00:00 26/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 26/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 26/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [00:00:00 26/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [00:00:00 26/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [00:00:00 26/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [00:00:00 26/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [00:00:00 26/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [00:00:00 26/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 26/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 442 u1: ml/B st: NotStopd t0: [00:00:00 26/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [00:00:00 26/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 261 u1: ml/B st: NotStopd t0: [00:00:00 26/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [00:00:00 26/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 26/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [23:08:00 25/12/2015] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.7 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 57.7 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.7 rs: Final st: NotStopd t0: [23:08:00 25/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 57.7 rs: Final st: NotStopd
t0: [01:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [01:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 26/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 107 u1: BPM st: NotStopd t0: [01:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [01:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [01:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [01:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [01:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [01:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [01:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [01:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [01:00:00 26/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [01:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [01:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [01:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [01:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 13.6125 vu: ml
t0: [00:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.22 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.22 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [01:00:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [01:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 26/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 109 u1: BPM st: NotStopd t0: [02:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [02:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [02:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [02:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [02:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [02:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [02:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [02:00:00 26/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [02:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [02:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [02:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [02:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 13.6125 vu: ml
t0: [02:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.22 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [02:00:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [02:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
id: Levophed-k el: 104 cu: CSRU cg: RN io: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions am: 32 du: mcgkgmin rt: IV Drip
t0: [02:57:00 26/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.41 rs: Final st: NotStopd t0: [02:57:00 26/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [02:57:00 26/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [02:57:00 26/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 36 u1: mmHg rs: Final st: NotStopd t0: [02:57:00 26/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 158 u1: mmHg rs: Final st: NotStopd t0: [02:57:00 26/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.41 rs: Final st: NotStopd
io: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ra: 6.80625 ru: ml/hr
id: D5W el: 1 cu: CSRU cg: RN io: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [02:57:00 26/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.3 rs: Final st: NotStopd t0: [02:57:00 26/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.21 rs: Final st: NotStopd t0: [02:57:00 26/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.3 rs: Final st: NotStopd t0: [02:57:00 26/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 99 u1: % rs: Final st: NotStopd
t0: [03:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 26/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 109 u1: BPM st: NotStopd t0: [03:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [03:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [03:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [03:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [03:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [03:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [03:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [03:00:00 26/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [03:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [03:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [03:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [03:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 13.6 vu: ml
t0: [03:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.22 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [03:00:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:08:00 25/12/2015] id: Vancomycin/Random Drug Level el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [03:15:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:15:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:15:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [03:15:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:15:00 26/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:15:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:15:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 108 u1: BPM st: NotStopd t0: [03:15:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [03:15:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [03:15:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [03:15:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:15:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [03:15:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [03:15:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 94 u1: % st: NotStopd t0: [03:15:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:15:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:15:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.21 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:15:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [03:15:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [03:15:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:42:00 26/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 12.2 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 12.2 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 29.6 u1: % rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 9.1 u1: gm/dl rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 319 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.32 u1: /mic l rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 12.2 rs: Final st: NotStopd t0: [02:57:00 26/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 12.5619 u1: ml/dl st: NotStopd
t0: [02:42:00 26/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 53 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 107 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 125 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 53 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 107 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 125 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [02:42:00 26/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd
t0: [03:00:00 26/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [03:00:00 26/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 26/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 26/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 26/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [03:00:00 26/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [03:00:00 26/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [03:00:00 26/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [04:00:00 26/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 26/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [04:00:00 26/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [04:00:00 26/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 26/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 26/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [04:00:00 26/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 26/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 26/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [04:00:00 26/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [04:00:00 26/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd
t0: [04:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 26/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 26/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 26/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [04:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [04:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [04:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [04:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [04:00:00 26/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [04:00:00 26/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.5 u1: Deg. C st: NotStopd t0: [04:00:00 26/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 99.5 u1: Deg. F st: NotStopd t0: [04:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [04:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [04:00:00 26/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [04:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [04:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [04:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [04:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 6.57422 vu: ml
t0: [04:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.23 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [04:00:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:00:00 26/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.6667 u1: ml/cmH st: NotStopd t0: [04:00:00 26/12/2015] id: RSBI Not Completed el: 0 cu: CSRU cg: RRT v1: Isch/Arrhythmia st: NotStopd t0: [04:00:00 26/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [04:00:00 26/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 26/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 26/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 26/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 26/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 26/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 26/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 26/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [04:00:00 26/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [04:00:00 26/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 12.2 u1: L/min st: NotStopd t0: [04:00:00 26/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 26/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 26/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [04:00:00 26/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [04:00:00 26/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [04:00:00 26/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 26/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [04:00:00 26/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [04:00:00 26/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 26/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 441 u1: ml/B st: NotStopd t0: [04:00:00 26/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [04:00:00 26/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [04:00:00 26/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 26/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 26/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: RN v1: Warm v2: Normal st: NotStopd t0: [00:00:00 26/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: RN v1: Warm v2: Normal st: NotStopd t0: [00:00:00 26/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: RN v1: Warm v2: Normal st: NotStopd t0: [00:00:00 26/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: RN v1: Warm v2: Normal st: NotStopd
t0: [04:30:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:30:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:30:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [04:30:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:30:00 26/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:30:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:30:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 108 u1: BPM st: NotStopd t0: [04:30:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:30:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [04:30:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [04:30:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:30:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [04:30:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [04:30:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 88 u1: % st: NotStopd t0: [04:30:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:30:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:30:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.22 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:30:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [04:30:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [04:30:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:00:00 26/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 26/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 26/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 26/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 26/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 26/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 26/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 26/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 26/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 26/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 26/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 26/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 26/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 26/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 26/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 26/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [04:00:00 26/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 26/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 26/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 26/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 26/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 109 u1: BPM st: NotStopd t0: [05:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [05:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [05:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [05:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [05:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [05:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [05:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [05:00:00 26/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [05:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [05:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [05:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [05:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 6.96094 vu: ml
t0: [05:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.22 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [05:00:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [05:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [06:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 26/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 108 u1: BPM st: NotStopd t0: [06:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 122 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [06:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [06:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [06:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [06:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 82 u1: % st: NotStopd t0: [06:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [06:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [06:00:00 26/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [06:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [06:00:00 26/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 250 vu: ml t0: [06:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [06:00:00 26/12/2015] tf: [15:00:00 26/12/2015] dt: 540 id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [06:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [06:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 6.80625 vu: ml t0: [06:00:00 26/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 20 vu: ml
t0: [06:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [06:00:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [06:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [06:00:00 26/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 26/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [06:00:00 26/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 26/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [06:00:00 26/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 26/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 26/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [06:00:00 26/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 26/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [06:00:00 26/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 26/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [06:00:00 26/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd
t0: [07:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [07:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 104 u1: BPM st: NotStopd t0: [07:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [07:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [07:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [07:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [07:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 39 u1: BPM st: NotStopd t0: [07:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [07:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [07:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [07:00:00 26/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 11.88 vu: ml t0: [07:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [07:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [07:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [07:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 6.1875 vu: ml
t0: [07:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [07:00:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 30 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [07:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [07:45:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 0 du: mcgkgmin sv: 50 su: vl rt: IV Drip
t0: [08:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [08:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [08:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 128 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [08:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [08:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [08:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 40 u1: BPM st: NotStopd t0: [08:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 26/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 26/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.8333 u1: Deg. C st: NotStopd t0: [08:00:00 26/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.5 u1: Deg. F st: NotStopd t0: [08:00:00 26/12/2015] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.14613 u1: m2 st: NotStopd t0: [08:00:00 26/12/2015] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.33978 u1: m2 st: NotStopd t0: [08:00:00 26/12/2015] id: Weight Change el: 0 cu: CSRU cg: RN v1: -1.3 u1: kg st: NotStopd t0: [08:00:00 26/12/2015] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd
t0: [08:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [08:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [08:00:00 26/12/2015] id: N/A 50.0vl + 500mcgkgmin Propofol IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 8.91 vu: ml t0: [08:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [08:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [08:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [08:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 6.1875 vu: ml
t0: [08:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [08:00:00 26/12/2015] id: Propofol el: 1 cu: CSRU cg: RN so: N/A vo: 0 v1: 0 du: mcgkgmin sv: 50 su: vl rt: IV Drip t0: [08:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:47:00 26/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.3333 u1: ml/cmH st: NotStopd t0: [08:47:00 26/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [08:47:00 26/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:47:00 26/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:47:00 26/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [08:47:00 26/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:47:00 26/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:47:00 26/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:47:00 26/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:47:00 26/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [08:47:00 26/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [08:47:00 26/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.5 u1: L/min st: NotStopd t0: [08:47:00 26/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:47:00 26/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:47:00 26/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [08:47:00 26/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [08:47:00 26/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:47:00 26/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 12 u1: BPM st: NotStopd t0: [08:47:00 26/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [08:47:00 26/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [08:47:00 26/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:47:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:47:00 26/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Rusty v2: Thick st: NotStopd t0: [08:47:00 26/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:47:00 26/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:47:00 26/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:47:00 26/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [08:47:00 26/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [08:50:00 26/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:50:00 26/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [08:50:00 26/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd
t0: [08:00:00 26/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 119 rs: Manual st: NotStopd t0: [08:00:00 26/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: RN v1: 119 rs: Manual st: NotStopd t0: [09:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 26/12/2015] id: Readmit <48 hrs el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 26/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [09:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 107 u1: BPM st: NotStopd t0: [09:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [09:00:00 26/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 26/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 26/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 125 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [09:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [09:00:00 26/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 26/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [09:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [09:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 39 u1: BPM st: NotStopd t0: [09:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 92 u1: % st: NotStopd t0: [09:00:00 26/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [09:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.19 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [09:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 26/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 26/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [08:00:00 26/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 26/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 26/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [08:00:00 26/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd
t0: [08:00:00 26/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 26/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 26/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 26/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 26/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 26/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 26/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 26/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 26/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 26/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [08:00:00 26/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 26/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 26/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 26/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 26/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 26/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 26/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Exp Wheeze st: NotStopd t0: [08:00:00 26/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 26/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 26/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 26/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 26/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [08:00:00 26/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [08:00:00 26/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [08:00:00 26/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [08:00:00 26/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 26/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 26/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 26/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 26/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 26/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 26/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 26/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 26/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 26/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 26/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [09:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [09:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [09:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [09:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [09:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [09:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 6.1875 vu: ml
t0: [09:20:00 26/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.33 rs: Final st: NotStopd t0: [09:20:00 26/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [09:20:00 26/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [09:20:00 26/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [09:20:00 26/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 190 u1: mmHg rs: Final st: NotStopd t0: [09:20:00 26/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.33 rs: Final st: NotStopd
t0: [09:20:00 26/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 12.5391 u1: ml/dl st: NotStopd t0: [09:20:00 26/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [09:53:00 26/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [09:53:00 26/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.5 u1: L/min st: NotStopd t0: [09:53:00 26/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [09:53:00 26/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [09:53:00 26/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [09:53:00 26/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd
t0: [09:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 109 u1: BPM st: NotStopd t0: [10:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [10:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 121 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [10:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [10:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [10:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [10:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 91 u1: % st: NotStopd t0: [10:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [10:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [10:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [10:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [10:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [10:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.87813 vu: ml
t0: [10:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.19 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [10:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 109 u1: BPM st: NotStopd t0: [11:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [11:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [11:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [11:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [11:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [11:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 35 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.18 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [11:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 26/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [11:00:00 26/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Scant st: NotStopd
t0: [11:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [11:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [11:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [11:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [11:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [11:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.87813 vu: ml
t0: [11:50:00 26/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.32 rs: Final st: NotStopd t0: [11:50:00 26/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 12.3469 u1: ml/dl st: NotStopd t0: [11:50:00 26/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [11:50:00 26/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [11:50:00 26/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 47 u1: mmHg rs: Final st: NotStopd t0: [11:50:00 26/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 128 u1: mmHg rs: Final st: NotStopd t0: [11:50:00 26/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.32 rs: Final st: NotStopd t0: [11:50:00 26/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [12:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 109 u1: BPM st: NotStopd t0: [12:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [12:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [12:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [12:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [12:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 84 u1: % st: NotStopd t0: [12:00:00 26/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 26/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [12:00:00 26/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [12:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 34 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [12:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:00:00 26/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [12:00:00 26/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 26/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 26/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 26/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 26/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 26/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 26/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [12:00:00 26/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 26/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 26/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd
t0: [12:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [12:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [12:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [12:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.7 vu: ml t0: [12:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [12:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.56875 vu: ml
t0: [12:00:00 26/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 26/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 26/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 26/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 26/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 26/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [12:00:00 26/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 26/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [12:00:00 26/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 26/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 26/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 26/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 26/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 26/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 26/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [12:00:00 26/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [12:00:00 26/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [12:00:00 26/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [12:00:00 26/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 26/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 26/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 26/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd
t0: [12:15:00 26/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [12:15:00 26/12/2015] id: Cuff Pressure-Airway el: 0 cu: CSRU cg: RRT u1: cmH2O st: NotStopd t0: [12:15:00 26/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [12:15:00 26/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:15:00 26/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:15:00 26/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [12:15:00 26/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:15:00 26/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [12:15:00 26/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:15:00 26/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:15:00 26/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [12:15:00 26/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [12:15:00 26/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 12.2 u1: L/min st: NotStopd t0: [12:15:00 26/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:15:00 26/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [12:15:00 26/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [12:15:00 26/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [12:15:00 26/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [12:15:00 26/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [12:15:00 26/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [12:15:00 26/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [12:15:00 26/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [12:15:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [12:15:00 26/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Brown v2: Plug st: NotStopd t0: [12:15:00 26/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [12:15:00 26/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [12:15:00 26/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [12:15:00 26/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [12:15:00 26/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [12:05:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:05:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:05:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:05:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 110 u1: BPM st: NotStopd t0: [12:05:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:05:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 115 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [12:05:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [12:05:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:05:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [12:05:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [12:05:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [12:05:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:10:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:10:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:10:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:10:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 140 u1: BPM st: NotStopd t0: [12:10:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 117 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [12:10:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [12:10:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:10:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [12:10:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [12:10:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [12:10:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 93 u1: % st: NotStopd t0: [12:10:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:15:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:15:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:15:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:15:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 141 u1: BPM st: NotStopd t0: [12:15:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [12:15:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [12:15:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:15:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [12:15:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [12:15:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [12:15:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:20:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:20:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:20:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:20:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 143 u1: BPM st: NotStopd t0: [12:20:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [12:20:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [12:20:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:20:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [12:20:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [12:20:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 89 u1: % st: NotStopd t0: [12:20:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:25:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:25:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:25:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:25:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:25:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 100 u1: BPM st: NotStopd t0: [12:25:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:25:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [12:25:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [12:25:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:25:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [12:25:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [12:25:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:30:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [12:35:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [12:40:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd
t0: [12:05:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 34 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:05:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:05:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [12:05:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [12:10:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 34 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:10:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:10:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [12:10:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [12:15:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 34 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:15:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:15:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [12:15:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [12:20:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 34 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:20:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:20:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [12:20:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [12:25:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 34 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:25:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:25:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [12:25:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 100 u1: BPM st: NotStopd t0: [13:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [13:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [13:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [13:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [13:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [13:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [13:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [13:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.68 vu: ml t0: [13:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [13:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.25938 vu: ml
t0: [13:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 34 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [13:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:00:00 26/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [09:00:00 26/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [09:00:00 26/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [09:00:00 26/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Called st: NotStopd t0: [09:00:00 26/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 26/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [09:00:00 26/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [09:00:00 26/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [09:00:00 26/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [09:00:00 26/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [09:00:00 26/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [09:00:00 26/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [09:00:00 26/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [09:00:00 26/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [09:00:00 26/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 26/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Relative st: NotStopd t0: [09:00:00 26/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [11:00:00 26/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [11:00:00 26/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Pt Verbalized st: NotStopd t0: [11:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [13:00:00 26/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [13:00:00 26/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Called st: NotStopd t0: [13:00:00 26/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [13:00:00 26/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [13:00:00 26/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [13:00:00 26/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [13:00:00 26/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [13:00:00 26/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [13:00:00 26/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [13:00:00 26/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd
t0: [14:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 101 u1: BPM st: NotStopd t0: [14:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [14:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [14:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [14:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [14:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 88 u1: % st: NotStopd t0: [14:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [14:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [10:00:00 29/12/2015] pt: IV Piggyback rt: IV fr: Q6H fs: 14, 20, 2, 8 dn: 4 m1: Piperacillin-Tazobactam Na v1: 2.25 u1: gm m2: Iso-Osmotic Dextrose v2: 50 u2: ml
t0: [14:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [14:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [14:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [14:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.68 vu: ml t0: [14:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [14:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.25938 vu: ml
t0: [14:47:00 26/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:1.6 st: NotStopd t0: [14:47:00 26/12/2015] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [14:47:00 26/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 28 u1: BPM st: NotStopd
tf: [14:00:00 27/12/2015] pt: IV Piggyback rt: IV fr: ONCE fs: 15 dn: 1 m1: Caspofungin Acetate v1: 70 u1: mg m2: NS v2: 250 u2: ml
t0: [14:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [15:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [15:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [15:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 109 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [15:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [15:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [15:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [15:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 91 u1: % st: NotStopd t0: [15:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [15:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [15:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [15:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [15:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [15:00:00 26/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 200 vu: ml t0: [15:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [15:00:00 26/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [15:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [15:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.25938 vu: ml t0: [15:00:00 26/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [15:17:00 26/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.7143 u1: ml/cmH st: NotStopd t0: [15:17:00 26/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [15:17:00 26/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [15:17:00 26/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [15:17:00 26/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [15:17:00 26/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [15:17:00 26/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:1.6 st: NotStopd t0: [15:17:00 26/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [15:17:00 26/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [15:17:00 26/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [15:17:00 26/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [15:17:00 26/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [15:17:00 26/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [15:17:00 26/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.4 u1: L/min st: NotStopd t0: [15:17:00 26/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [15:17:00 26/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [15:17:00 26/12/2015] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [15:17:00 26/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [15:17:00 26/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [15:17:00 26/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [15:17:00 26/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 4 u1: BPM st: NotStopd t0: [15:17:00 26/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [15:17:00 26/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [15:17:00 26/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [15:17:00 26/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Brown v2: Thin st: NotStopd t0: [15:17:00 26/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [15:17:00 26/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [15:17:00 26/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [15:17:00 26/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [15:17:00 26/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [16:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 106 u1: BPM st: NotStopd t0: [16:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [16:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [16:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [16:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [16:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [16:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 92 u1: % st: NotStopd t0: [16:00:00 26/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 26/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [16:00:00 26/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [16:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [16:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 26/12/2015] id: Corneal Reflex R/L el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [16:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [16:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [16:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [16:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [16:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [16:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.25938 vu: ml
t0: [16:00:00 26/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 26/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 26/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 26/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 26/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 26/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [16:00:00 26/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 26/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 26/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 26/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 26/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 26/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 26/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 26/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [16:00:00 26/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 26/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 26/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 26/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [16:00:00 26/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [16:00:00 26/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [16:00:00 26/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [16:00:00 26/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [16:00:00 26/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 26/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 26/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 26/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 26/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 26/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd
t0: [17:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [17:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [17:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [17:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [17:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [17:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [17:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [17:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [17:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [17:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [17:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [17:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.25938 vu: ml
t0: [17:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.17 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [17:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [18:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [18:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [18:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [18:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [18:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.25938 vu: ml
t0: [18:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 109 u1: BPM st: NotStopd t0: [18:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [18:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [18:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [18:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [18:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [18:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 91 u1: % st: NotStopd t0: [18:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.16 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [18:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [19:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [19:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [19:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [19:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [19:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [19:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 4.95 vu: ml
t0: [23:00:00 26/12/2015] dt: 24 id: Stool Out Total el: 3 cu: CSRU cg: RN cv: 1 ap: none
t0: [16:00:00 26/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [16:00:00 26/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [16:00:00 26/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 26/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [16:00:00 26/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [16:00:00 26/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [19:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [19:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 108 u1: BPM st: NotStopd t0: [19:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 120 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [19:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [19:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [19:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [19:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 80 u1: % st: NotStopd t0: [19:00:00 26/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [19:00:00 26/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [19:00:00 26/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [19:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.16 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [19:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 26/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 26/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 26/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 26/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [16:00:00 26/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 26/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [16:00:00 26/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [19:00:00 26/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [19:00:00 26/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [19:00:00 26/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [19:00:00 26/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [19:00:00 26/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [19:00:00 26/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [19:00:00 26/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [19:00:00 26/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd
t0: [19:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd
id: Amiodarone el: 100 cu: CSRU cg: RN io: D5W 250.0ml + 600mgmin Amiodarone IV Infusions am: 600 du: mgmin rt: IV Drip
tf: [02:00:00 27/12/2015] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Amiodarone HCl v1: 600 u1: mg m2: D5W (EXCEL BAG) v2: 250 u2: ml tf: [14:00:00 27/12/2015] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Amiodarone HCl v1: 600 u1: mg m2: D5W (EXCEL BAG) v2: 250 u2: ml tf: [19:00:00 27/12/2015] pt: Unit Dose rt: IV fr: ONCE fs: 20 dn: 1 m1: Amiodarone HCl v1: 150 u1: mg tf: [19:00:00 27/12/2015] pt: Unit Dose rt: IV fr: ONCE MR1 fs: 20 dn: 1 m1: Metoprolol v1: 5 u1: mg
id: D5W el: 1 cu: CSRU cg: RN io: D5W 250.0ml + 600mgmin Amiodarone IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [19:45:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:45:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:45:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [19:45:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:45:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:45:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 146 u1: BPM st: NotStopd t0: [19:45:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [19:45:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [19:45:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [19:45:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:45:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [19:45:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [19:45:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 91 u1: % st: NotStopd t0: [19:45:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [19:50:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:50:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:50:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:50:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:50:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 156 u1: BPM st: NotStopd t0: [19:50:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [19:50:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [19:50:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 57 u1: mmHg st: NotStopd t0: [19:50:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:50:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [19:50:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [19:50:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 92 u1: % st: NotStopd t0: [19:50:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [19:55:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:55:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:55:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [19:55:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:55:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:55:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [19:55:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [19:55:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [19:55:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [19:55:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:55:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [19:55:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [19:55:00 26/12/2015] id: Significant Events el: 0 cu: CSRU cg: RN v1: Cardioversion st: NotStopd t0: [19:55:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 95 u1: % st: NotStopd t0: [19:55:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 114 u1: BPM st: NotStopd t0: [20:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [20:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [20:00:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [20:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [20:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 90 u1: % st: NotStopd t0: [20:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:05:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:05:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:05:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:05:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:05:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 114 u1: BPM st: NotStopd t0: [20:05:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:05:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [20:05:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [20:05:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:05:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [20:05:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [20:05:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [20:05:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 84 u1: % st: NotStopd t0: [20:05:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:10:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:10:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:10:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:10:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:10:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 108 u1: BPM st: NotStopd t0: [20:10:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:10:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [20:10:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [20:10:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:10:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [20:10:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [20:10:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 87 u1: % st: NotStopd t0: [20:10:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:15:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:15:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:15:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:15:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:15:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 110 u1: BPM st: NotStopd t0: [20:15:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:15:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [20:15:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [20:15:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:15:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [20:15:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [20:15:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 92 u1: % st: NotStopd t0: [20:15:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:30:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:30:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:30:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:30:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:30:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 111 u1: BPM st: NotStopd t0: [20:30:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:30:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 150 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [20:30:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [20:30:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:30:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [20:30:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [20:30:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 90 u1: % st: NotStopd t0: [20:30:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:45:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:45:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:45:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:45:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:45:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 107 u1: BPM st: NotStopd t0: [20:45:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [20:45:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 129 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [20:45:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [20:45:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:45:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [20:45:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [20:45:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 92 u1: % st: NotStopd t0: [20:45:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [20:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [20:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [20:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [20:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.15625 vu: ml
t0: [19:45:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:45:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.16 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:45:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [19:45:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [19:50:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:50:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:50:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [19:50:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [19:55:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:55:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:55:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [19:55:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 26/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 25 su: ml rt: IV Drip st: Stopped t0: [20:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:05:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:05:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:05:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:10:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:10:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:10:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:15:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:15:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:15:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:30:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:30:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.18 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:30:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:45:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:45:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.16 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:45:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [19:50:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RRT v1: 70.4 u1: kg st: NotStopd t0: [19:55:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RRT v1: 70.4 u1: kg st: NotStopd t0: [20:10:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RRT v1: 70.4 u1: kg st: NotStopd t0: [20:15:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RRT v1: 70.4 u1: kg st: NotStopd t0: [20:30:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RRT v1: 70.4 u1: kg st: NotStopd t0: [20:44:00 26/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.1935 u1: ml/cmH st: NotStopd t0: [20:44:00 26/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [20:44:00 26/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:44:00 26/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:44:00 26/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:44:00 26/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [20:44:00 26/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1.7 st: NotStopd t0: [20:44:00 26/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:44:00 26/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:44:00 26/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:44:00 26/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:44:00 26/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [20:44:00 26/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [20:44:00 26/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.1 u1: L/min st: NotStopd t0: [20:44:00 26/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:44:00 26/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:44:00 26/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [20:44:00 26/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [20:44:00 26/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:44:00 26/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [20:44:00 26/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [20:44:00 26/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [20:44:00 26/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:44:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 88 u1: % st: NotStopd t0: [20:44:00 26/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 438 u1: ml/B st: NotStopd t0: [20:44:00 26/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [20:44:00 26/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [20:44:00 26/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [20:45:00 26/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RRT v1: 70.4 u1: kg st: NotStopd
t0: [20:00:00 26/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 26/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 102 u1: BPM st: NotStopd t0: [21:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [21:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [21:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [21:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [21:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 92 u1: % st: NotStopd t0: [21:00:00 26/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [21:00:00 26/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [21:00:00 26/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [21:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 5 vu: ml t0: [21:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [21:00:00 26/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vu: ml nb: 1 t0: [21:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [21:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [21:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 5.72344 vu: ml
t0: [21:00:00 26/12/2015] tf: [09:53:00 12/01/2016] dt: 23813 id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.16 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [21:00:00 26/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 120 vu: ml t0: [21:00:00 26/12/2015] tf: [04:00:00 27/12/2015] dt: 420 id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [21:00:00 26/12/2015] tf: [04:00:00 27/12/2015] dt: 420 id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 25 vu: ml
t0: [23:00:00 26/12/2015] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 175 ap: none t0: [23:00:00 26/12/2015] dt: 24 id: Drain #1 Total Out el: 3 cu: CSRU cg: RN cv: 570 ap: none
t0: [21:52:00 26/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.45 rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 12.5174 u1: ml/dl st: NotStopd t0: [21:52:00 26/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 111 rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 2 rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 36 u1: mmHg rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 183 u1: mmHg rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.45 rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 111 rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.21 rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
tf: [08:00:00 29/12/2015] pt: IV Piggyback rt: IV fr: Q24H fs: 0 dn: 1 m1: Vancomycin HCl v1: 1000 u1: mg m2: Iso-Osmotic Dextrose v2: 200 u2: ml
t0: [22:00:00 26/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd
t0: [22:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 99 u1: BPM st: NotStopd t0: [22:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 121 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [22:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [22:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [22:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [22:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 26/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 20 vu: ml t0: [22:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [22:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [22:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [22:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 4.95 vu: ml
t0: [22:00:00 26/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.16 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 900 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:00:00 26/12/2015] tf: [13:00:00 31/12/2015] dt: 6660 id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 25 vu: ml
t0: [23:00:00 26/12/2015] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 30 ap: none
t0: [23:00:00 26/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 26/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 26/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [23:00:00 26/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 26/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 26/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 97 u1: BPM st: NotStopd t0: [23:00:00 26/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 26/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 121 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [23:00:00 26/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [23:00:00 26/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 26/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [23:00:00 26/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 26/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml st: Stopped t0: [22:00:00 26/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vu: ml t0: [22:00:00 26/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vu: ml t0: [23:00:00 26/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 9 vu: ml t0: [23:00:00 26/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 25 vu: ml t0: [23:00:00 26/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [23:00:00 26/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [23:00:00 26/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 4.95 vu: ml
t0: [23:00:00 26/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 26/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 26/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 26/12/2015] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 130 cv: 130 ap: none t0: [23:00:00 26/12/2015] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 960 ap: none t0: [23:00:00 26/12/2015] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 130 cv: 4020 ap: none t0: [23:00:00 26/12/2015] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 130 cv: 4766 ap: none
t0: [23:00:00 26/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.14 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [00:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 27/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 27/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 94 u1: BPM st: NotStopd t0: [00:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 118 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [00:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [00:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [00:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [00:00:00 27/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [00:00:00 27/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [00:00:00 27/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [00:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 27/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 15 vu: ml t0: [00:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [00:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 25 vu: ml t0: [00:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [00:00:00 27/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 60 vu: ml t0: [00:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [00:00:00 27/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [00:00:00 27/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 4.33125 vu: ml t0: [00:00:00 27/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 10 vu: ml
t0: [00:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 27/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.12 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 27/12/2015] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN pv: 60 cv: 810 ap: none t0: [23:00:00 27/12/2015] dt: 24 id: Drain #1 Total Out el: 3 cu: CSRU cg: RN cv: 580 ap: none
t0: [21:52:00 26/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 4 rs: Final st: NotStopd t0: [21:52:00 26/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 4 rs: Final st: NotStopd t0: [21:54:00 26/12/2015] id: PTT Coags el: 0 cu: CSRU cg: RN v1: 47.8 rs: Final st: NotStopd t0: [21:54:00 26/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: RN v1: 47.8 rs: Final st: NotStopd
t0: [21:00:00 26/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml
t0: [01:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 91 u1: BPM st: NotStopd t0: [01:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [01:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [01:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [01:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 27/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 10 vu: ml t0: [01:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [01:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 25 vu: ml t0: [01:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [01:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [01:00:00 27/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 3.7125 vu: ml
t0: [01:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 27/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [01:00:00 27/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.3333 u1: ml/cmH st: NotStopd t0: [01:00:00 27/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [01:00:00 27/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [01:00:00 27/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [01:00:00 27/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [01:00:00 27/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [01:00:00 27/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1.7 st: NotStopd t0: [01:00:00 27/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [01:00:00 27/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [01:00:00 27/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:00:00 27/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 27/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [01:00:00 27/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [01:00:00 27/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.6 u1: L/min st: NotStopd t0: [01:00:00 27/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 27/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 27/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [01:00:00 27/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [01:00:00 27/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [01:00:00 27/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [01:00:00 27/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [01:00:00 27/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [01:00:00 27/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [01:00:00 27/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Clear st: NotStopd t0: [01:00:00 27/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [01:00:00 27/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 439 u1: ml/B st: NotStopd t0: [01:00:00 27/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [01:00:00 27/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [01:00:00 27/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 26/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 26/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 26/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 26/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 26/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 26/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [20:00:00 26/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 26/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [20:00:00 26/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 26/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 26/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 26/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 26/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 26/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 26/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 26/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 26/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 26/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 26/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 26/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 26/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 26/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 26/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 26/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 26/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 26/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 26/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 26/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 26/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 26/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 26/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 26/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [20:00:00 26/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 26/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 26/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 26/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 26/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 26/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 26/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 26/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [20:00:00 26/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [20:00:00 26/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 26/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 26/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Fair st: NotStopd t0: [20:00:00 26/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 26/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 26/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 26/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 26/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 26/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 26/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 26/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 26/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 26/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [20:00:00 26/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 26/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 26/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 26/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [20:00:00 26/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [20:00:00 26/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [20:00:00 26/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [20:00:00 26/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [20:00:00 26/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [20:00:00 26/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 26/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 26/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 26/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [20:00:00 26/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 26/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 26/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 26/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 26/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 26/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 26/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 26/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 26/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 26/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 26/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 26/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [20:00:00 26/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 26/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 26/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 26/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Anxious st: NotStopd t0: [20:00:00 26/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 26/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 26/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 26/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 26/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 26/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 26/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 13 u1: number st: NotStopd t0: [20:00:00 26/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 26/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 26/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [20:00:00 26/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 26/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 26/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 26/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 26/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [21:00:00 26/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [21:00:00 26/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 26/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 26/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 26/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [21:00:00 26/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 26/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 26/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [21:00:00 26/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [21:00:00 26/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 26/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 26/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 27/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 27/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 27/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 27/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 27/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 27/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 27/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 27/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [00:00:00 27/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 27/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 27/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 27/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 27/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 27/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 27/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 27/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 27/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 27/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 27/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 27/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 27/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 27/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 27/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 27/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 27/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 27/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 27/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Not Done st: NotStopd t0: [00:00:00 27/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 27/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 27/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 27/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 27/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 st: NotStopd t0: [00:00:00 27/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 27/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 27/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 27/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [00:00:00 27/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 27/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 27/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 27/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [00:00:00 27/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [00:00:00 27/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 27/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 27/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 27/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 27/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 27/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 27/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 27/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 27/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 27/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 27/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 27/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 27/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [00:00:00 27/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 27/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 27/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 27/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 27/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 27/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [00:00:00 27/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [00:00:00 27/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Attached-pacer st: NotStopd t0: [00:00:00 27/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [00:00:00 27/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [00:00:00 27/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 27/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 27/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 27/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [00:00:00 27/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [00:00:00 27/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [00:00:00 27/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 27/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 27/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 27/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 27/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 27/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 27/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 27/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 27/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 27/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 27/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 27/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 27/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 27/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 27/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 27/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 27/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [00:00:00 27/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [00:00:00 27/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 27/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [00:00:00 27/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 27/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 27/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 27/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 27/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [23:00:00 26/12/2015] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: 3161 pv: -50.41 cv: -50.41 ap: none t0: [23:00:00 26/12/2015] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: 3161 pv: 39.59 cv: 1426.78 ap: none t0: [23:00:00 26/12/2015] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: 3161 pv: 79.59 cv: 2416.78 ap: none t0: [23:00:00 26/12/2015] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: 3161 pv: -50.41 cv: -2349.22 ap: none t0: [23:00:00 26/12/2015] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: 3161 pv: -50.41 cv: 7851.84 ap: carryForward
t0: [02:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 86 u1: BPM st: NotStopd t0: [02:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [02:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [02:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [02:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 85 u1: % st: NotStopd t0: [02:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [02:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 25 vu: ml t0: [02:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [02:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [02:00:00 27/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 3.09375 vu: ml
t0: [02:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 27/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.08 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 27/12/2015] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 140 cv: 140 ap: none t0: [23:00:00 27/12/2015] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -26.25 cv: -26.25 ap: none t0: [23:00:00 27/12/2015] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 23.75 cv: 1563 ap: none t0: [23:00:00 27/12/2015] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 113.75 cv: 3783 ap: none t0: [23:00:00 27/12/2015] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 960 ap: none t0: [23:00:00 27/12/2015] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 80 cv: 2115 ap: none t0: [23:00:00 27/12/2015] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -26.25 cv: 277.999 ap: none t0: [23:00:00 27/12/2015] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 140 cv: 3505 ap: none t0: [23:00:00 27/12/2015] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -26.25 cv: 8129.84 ap: carryForward
t0: [03:51:00 27/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.38 rs: Final st: NotStopd t0: [03:51:00 27/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 127 rs: Final st: NotStopd t0: [03:51:00 27/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [03:51:00 27/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [03:51:00 27/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 42 u1: mmHg rs: Final st: NotStopd t0: [03:51:00 27/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 102 u1: mmHg rs: Final st: NotStopd t0: [03:51:00 27/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.38 rs: Final st: NotStopd t0: [03:51:00 27/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 127 rs: Final st: NotStopd t0: [03:51:00 27/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.17 rs: Final st: NotStopd t0: [03:51:00 27/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 97 u1: % rs: Final st: NotStopd
t0: [03:51:00 27/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 12.2744 u1: ml/dl st: NotStopd t0: [04:06:00 27/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.6 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 13.6 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 28.8 u1: % rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 9.2 u1: gm/dl rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 295 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.21 u1: /mic l rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.6 rs: Final st: NotStopd
t0: [01:00:00 27/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [05:00:00 27/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.75 u1: ml/cmH st: NotStopd t0: [05:00:00 27/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [05:00:00 27/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [05:00:00 27/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [05:00:00 27/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [05:00:00 27/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [05:00:00 27/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1.7 st: NotStopd t0: [05:00:00 27/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:00:00 27/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [05:00:00 27/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:00:00 27/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 27/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [05:00:00 27/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [05:00:00 27/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [05:00:00 27/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [05:00:00 27/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 27/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 27/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [05:00:00 27/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [05:00:00 27/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [05:00:00 27/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [05:00:00 27/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [05:00:00 27/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [05:00:00 27/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [05:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [05:00:00 27/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 439 u1: ml/B st: NotStopd t0: [05:00:00 27/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [05:00:00 27/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [05:00:00 27/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [05:00:00 27/12/2015] id: IV #1 Reason DC'D el: 0 cu: CSRU cg: -1 st: D/C'd t0: [05:00:00 27/12/2015] id: IV #1 D/C Date el: 0 cu: CSRU cg: -1 st: D/C'd t0: [05:00:00 27/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: -1 st: D/C'd t0: [05:00:00 27/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: -1 st: D/C'd t0: [05:00:00 27/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: -1 st: D/C'd t0: [05:00:00 27/12/2015] id: Temperature C el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [05:00:00 27/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: -1 ai: 109 vo: 0 st: D/C'd
id: .9% Normal Saline el: 1 cu: CCU cg: RN io: .9% Normal Saline 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push
t0: [20:00:00 26/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 26/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 27/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 27/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [03:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 82 u1: BPM st: NotStopd t0: [03:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 109 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [03:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [03:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [03:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [03:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:51:00 27/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 3.9 rs: Final st: NotStopd t0: [03:51:00 27/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 3.9 rs: Final st: NotStopd t0: [04:00:00 27/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 27/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 27/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 27/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 27/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 27/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 27/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [04:00:00 27/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 27/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 27/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 27/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 27/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 27/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 27/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 27/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 27/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 27/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 27/12/2015] id: IV #1 Reason DC'D el: 0 cu: CSRU cg: RN v1: Treatment DC'D st: NotStopd t0: [04:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 27/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [04:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 27/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 27/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 27/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 27/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 27/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 27/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 27/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 27/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 27/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Not Done st: NotStopd t0: [04:00:00 27/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 27/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 27/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 80 u1: BPM st: NotStopd t0: [04:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 27/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 27/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 27/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [04:00:00 27/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 27/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 27/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 27/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [04:00:00 27/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 27/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 27/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 27/12/2015] id: IV #1 D/C Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [04:00:00 27/12/2015] id: IV #1 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [04:00:00 27/12/2015] id: IV #1 Site/Size el: 0 cu: CSRU cg: RN v1: Left Antecub v2: 14 gauge st: NotStopd t0: [04:00:00 27/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [04:00:00 27/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [04:00:00 27/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 27/12/2015] id: IV Site Appear #1 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 27/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 27/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 27/12/2015] id: Imp Skin Cleanse #1 el: 0 cu: CSRU cg: RN v1: Soap & H20 st: NotStopd t0: [04:00:00 27/12/2015] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [04:00:00 27/12/2015] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: Serosanguinous v2: Small st: NotStopd t0: [04:00:00 27/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 27/12/2015] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Red st: NotStopd t0: [04:00:00 27/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 27/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 27/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 27/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 27/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 27/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 27/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 27/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 27/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 27/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 27/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 27/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 27/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 27/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 27/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 27/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [04:00:00 27/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [04:00:00 27/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [04:00:00 27/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [04:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 110 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [04:00:00 27/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [04:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [04:00:00 27/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 27/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 27/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [04:00:00 27/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 27/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [04:00:00 27/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 27/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 27/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 27/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 27/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 27/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 27/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [04:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 27/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [04:00:00 27/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 27/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [04:00:00 27/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 27/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Amber v2: Clear st: NotStopd t0: [04:00:00 27/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 27/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 27/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 27/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [04:00:00 27/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [04:00:00 27/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 27/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [04:00:00 27/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 27/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 27/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 27/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 27/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [05:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 96 u1: BPM st: NotStopd t0: [05:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [05:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [05:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [05:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [05:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [05:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [03:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 25 vu: ml t0: [03:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [03:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [03:00:00 27/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 2.475 vu: ml t0: [04:00:00 27/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [04:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [04:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 25 vu: ml t0: [04:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [04:00:00 27/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 110 vu: ml t0: [04:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [04:00:00 27/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [05:00:00 27/12/2015] tf: [09:00:00 28/12/2015] dt: 1680 id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vu: ml st: Restart t0: [04:00:00 27/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: RN ai: 210 vo: 1.85625 vu: ml st: Stopped t0: [04:00:00 27/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [05:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [05:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 18.75 vu: ml t0: [05:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [05:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [05:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0.8 vu: ml
t0: [03:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 27/12/2015] tf: [06:00:00 28/12/2015] dt: 1560 id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [04:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 27/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 25 su: ml rt: IV Drip t0: [04:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [04:30:00 27/12/2015] id: Levophed-k el: 1 cu: CSRU cg: RN so: D5W vo: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped t0: [05:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 32 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 25 su: ml rt: IV Drip t0: [05:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [05:00:00 27/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml
t0: [20:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [21:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [22:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [23:00:00 26/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [00:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [01:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [02:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [03:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [04:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [04:00:00 27/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [04:00:00 27/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.8 u1: Deg. F st: NotStopd
t0: [04:06:00 27/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 53 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 107 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.9 u1: mEq/L rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 53 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 107 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.9 u1: mEq/L rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd
t0: [04:06:00 27/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: RN v1: 1.9 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: RN v1: 1.9 rs: Final st: NotStopd
t0: [01:00:00 27/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vu: ml st: Stopped t0: [01:00:00 27/12/2015] tf: [14:00:00 30/12/2015] dt: 5100 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml nb: 1 t0: [02:00:00 27/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vu: ml t0: [02:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 27/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vu: ml t0: [03:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 27/12/2015] id: Lactated Ringers IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vu: ml t0: [04:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml
t0: [00:23:00 27/12/2015] id: Vancomycin/Random Drug Level el: 0 cu: CSRU cg: RN v1: 24 rs: Final st: NotStopd
t0: [06:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 100 u1: BPM st: NotStopd t0: [06:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [06:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [06:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [06:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [06:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [06:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [07:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 103 u1: BPM st: NotStopd t0: [07:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [07:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [07:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [07:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [07:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [07:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [06:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [06:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [06:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.64 vu: ml t0: [06:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0.75 vu: ml t0: [07:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [07:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [07:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [07:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.5 vu: ml t0: [07:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [06:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [06:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [07:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [07:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [14:00:00 25/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [04:06:00 27/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 60.7 rs: Final st: NotStopd t0: [04:06:00 27/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 60.7 rs: Final st: NotStopd t0: [07:00:00 27/12/2015] id: Previous Weight el: 0 cu: CSRU cg: 3161 v1: 70.4 u1: kg st: NotStopd
t0: [08:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [08:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [08:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [08:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.5 vu: ml t0: [08:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [08:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 103 u1: BPM st: NotStopd t0: [08:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [08:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [08:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [08:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 70.4 u1: kg st: NotStopd t0: [08:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [08:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 27/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 27/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [08:00:00 27/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [08:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [08:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:30:00 27/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 11.2821 u1: ml/cmH st: NotStopd t0: [08:30:00 27/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [08:30:00 27/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:30:00 27/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:30:00 27/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:30:00 27/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [08:30:00 27/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:1.7 st: NotStopd t0: [08:30:00 27/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:30:00 27/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:30:00 27/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:30:00 27/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:30:00 27/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [08:30:00 27/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:30:00 27/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [08:30:00 27/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [08:30:00 27/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.6 u1: L/min st: NotStopd t0: [08:30:00 27/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:30:00 27/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:30:00 27/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 44 u1: cmH2O st: NotStopd t0: [08:30:00 27/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:30:00 27/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:30:00 27/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [08:30:00 27/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [08:30:00 27/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [08:30:00 27/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:30:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [08:30:00 27/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: None st: NotStopd t0: [08:30:00 27/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 444 u1: ml/B st: NotStopd t0: [08:30:00 27/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:30:00 27/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [08:30:00 27/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [09:00:00 27/12/2015] id: LLE Temp/Color el: 0 cu: CSRU cg: -1 st: D/C'd t0: [09:00:00 27/12/2015] id: LUE Temp/Color el: 0 cu: CSRU cg: -1 st: D/C'd t0: [09:00:00 27/12/2015] id: RLE Temp/Color el: 0 cu: CSRU cg: -1 st: D/C'd t0: [09:00:00 27/12/2015] id: RUE Temp/Color el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [08:00:00 27/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 27/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 27/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 27/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 27/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 27/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 27/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 27/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 27/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 27/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 27/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 27/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [08:00:00 27/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 27/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 27/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 27/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 27/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 27/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 27/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 27/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 27/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 27/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 27/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 27/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 27/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 27/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 27/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 27/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [08:00:00 27/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [08:00:00 27/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [08:00:00 27/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [08:00:00 27/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [08:00:00 27/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 27/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 27/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 27/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 27/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 27/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 27/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [08:00:00 27/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 27/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 27/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 27/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [09:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [09:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [09:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [09:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.5 vu: ml t0: [09:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [09:00:00 27/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [09:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd
t0: [08:00:00 27/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 27/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [08:00:00 27/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 27/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 27/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [08:00:00 27/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd
t0: [09:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [09:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [09:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [09:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [09:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 27/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [09:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [09:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [09:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 27/12/2015] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.09417 u1: m2 st: NotStopd t0: [09:00:00 27/12/2015] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.28038 u1: m2 st: NotStopd t0: [09:00:00 27/12/2015] id: Weight Change el: 0 cu: CSRU cg: RN v1: 0 u1: kg st: NotStopd t0: [09:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 27/12/2015] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd
t0: [09:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 25 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [09:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [12:00:00 28/12/2015] pt: Unit Dose rt: NG fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 12.5 u1: mg tf: [15:00:00 12/02/2016] pt: IV Piggyback rt: IV fr: QD fs: 16 dn: 1 m1: Caspofungin Acetate v1: 50 u1: mg m2: NS v2: 250 u2: ml
t0: [10:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [10:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [10:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [10:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.5 vu: ml t0: [10:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [10:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 100 u1: BPM st: NotStopd t0: [10:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [10:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [10:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [10:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [10:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [10:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 20 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [10:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 98 u1: BPM st: NotStopd t0: [11:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [11:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [11:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [11:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [11:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [11:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 15 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [11:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [11:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [11:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [11:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.4 vu: ml t0: [11:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [11:00:00 27/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [11:00:00 27/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:00:00 27/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [11:00:00 27/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [11:00:00 27/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:00:00 27/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.5 u1: L/min st: NotStopd t0: [11:00:00 27/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 27/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [11:00:00 27/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [11:00:00 27/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [11:00:00 27/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [11:00:00 27/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [11:00:00 27/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [11:00:00 27/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [07:00:00 27/12/2015] id: Radiologic Study el: 0 cu: CSRU cg: RN v1: Chest Xray st: NotStopd
t0: [12:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 103 u1: BPM st: NotStopd t0: [12:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [12:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [12:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [12:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [12:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [12:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 27/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 27/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [12:00:00 27/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [12:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 10 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [12:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 27/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 27/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 27/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 27/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 27/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves st: NotStopd t0: [08:00:00 27/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 27/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 27/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 27/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [10:00:00 27/12/2015] id: shampoo el: 0 cu: CSRU cg: RN v1: done t0: [10:00:00 27/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [10:00:00 27/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 27/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 27/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 27/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [10:00:00 27/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 27/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [10:00:00 27/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd
t0: [09:00:00 27/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [09:00:00 27/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [09:00:00 27/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [09:00:00 27/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [09:00:00 27/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [09:00:00 27/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [09:00:00 27/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 27/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [09:00:00 27/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [09:00:00 27/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [09:00:00 27/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [09:00:00 27/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [09:00:00 27/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [09:00:00 27/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [09:00:00 27/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [09:00:00 27/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [09:00:00 27/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 27/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [09:00:00 27/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Relative st: NotStopd t0: [09:00:00 27/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [09:00:00 27/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [09:00:00 27/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [09:00:00 27/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [09:00:00 27/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Moist st: NotStopd t0: [09:00:00 27/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [09:00:00 27/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 11 u1: number st: NotStopd t0: [09:00:00 27/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd
t0: [12:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [12:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [12:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [12:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.3 vu: ml t0: [12:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [13:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [13:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [13:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [13:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.2 vu: ml t0: [13:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [13:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 101 u1: BPM st: NotStopd t0: [13:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [13:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [13:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [13:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [13:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [13:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 5 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [13:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:00:00 27/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.3333 u1: ml/cmH st: NotStopd t0: [13:00:00 27/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [13:00:00 27/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [13:00:00 27/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [13:00:00 27/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [13:00:00 27/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [13:00:00 27/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.5 st: NotStopd t0: [13:00:00 27/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:00:00 27/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [13:00:00 27/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [13:00:00 27/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [13:00:00 27/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [13:00:00 27/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [13:00:00 27/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [13:00:00 27/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [13:00:00 27/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 14.4 u1: L/min st: NotStopd t0: [13:00:00 27/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:00:00 27/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [13:00:00 27/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [13:00:00 27/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [13:00:00 27/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [13:00:00 27/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [13:00:00 27/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [13:00:00 27/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [13:00:00 27/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [13:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [13:00:00 27/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White v2: Thick st: NotStopd t0: [13:00:00 27/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [13:00:00 27/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 443 u1: ml/B st: NotStopd t0: [13:00:00 27/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [13:00:00 27/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [13:00:00 27/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [13:04:00 27/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.32 rs: Final st: NotStopd t0: [13:04:00 27/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 12.1263 u1: ml/dl st: NotStopd t0: [13:04:00 27/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 121 rs: Final st: NotStopd t0: [13:04:00 27/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [13:04:00 27/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [13:04:00 27/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 46 u1: mmHg rs: Final st: NotStopd t0: [13:04:00 27/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 94 u1: mmHg rs: Final st: NotStopd t0: [13:04:00 27/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.32 rs: Final st: NotStopd t0: [13:04:00 27/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 121 rs: Final st: NotStopd t0: [13:04:00 27/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 96 u1: % rs: Final st: NotStopd
t0: [13:04:00 27/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 3.6 rs: Final st: NotStopd t0: [13:04:00 27/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 3.6 rs: Final st: NotStopd
t0: [14:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [14:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [14:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [14:00:00 27/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 300 vu: ml t0: [14:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: RN ai: 416 vo: 0.1 vu: ml t0: [14:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [15:00:00 27/12/2015] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CSRU cg: -1 ai: 416 vo: 0 st: D/C'd
t0: [14:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 95 u1: BPM st: NotStopd t0: [14:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [14:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [14:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [14:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [14:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [14:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 100 u1: BPM st: NotStopd t0: [15:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [15:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [15:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [15:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [15:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [15:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [15:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 27/12/2015] id: Fentanyl el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [14:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [15:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 25 su: ml rt: IV Drip t0: [15:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [15:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [15:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [15:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [15:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [13:00:00 27/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [13:00:00 27/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 27/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 27/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [13:00:00 27/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:00:00 27/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [14:00:00 27/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [15:00:00 27/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [15:00:00 27/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 27/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 27/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 27/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [15:00:00 27/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 27/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [15:00:00 27/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [15:00:00 27/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd
t0: [15:20:00 27/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [15:20:00 27/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [15:20:00 27/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [15:20:00 27/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [15:20:00 27/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [15:20:00 27/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [15:20:00 27/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [15:20:00 27/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [15:20:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 98 u1: % st: NotStopd t0: [15:20:00 27/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [15:20:00 27/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [15:20:00 27/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [14:00:00 27/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [15:00:00 27/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml
t0: [13:00:00 27/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [13:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd
t0: [15:00:00 27/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [16:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 91 u1: BPM st: NotStopd t0: [16:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [16:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [16:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [16:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [16:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [16:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 95 u1: % st: NotStopd t0: [16:00:00 27/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 27/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36 u1: Deg. C st: NotStopd t0: [16:00:00 27/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.8 u1: Deg. F st: NotStopd t0: [16:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 25 su: ml rt: IV Drip t0: [16:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [16:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [16:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [16:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0.75 vu: ml
tf: [21:00:00 26/02/2016] pt: IV Piggyback rt: IV fr: QD fs: 16 dn: 1 m1: Caspofungin Acetate v1: 50 u1: mg m2: NS v2: 250 u2: ml
t0: [16:00:00 27/12/2015] tf: [09:53:00 12/01/2016] dt: 22673 id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 500 vu: ml t0: [16:00:00 27/12/2015] tf: [14:00:00 29/12/2015] dt: 2760 id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 400 vu: ml t0: [16:00:00 27/12/2015] tf: [20:00:00 27/12/2015] dt: 240 id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 10 vu: ml
t0: [16:13:00 27/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.4 rs: Final st: NotStopd t0: [16:13:00 27/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 12.5588 u1: ml/dl st: NotStopd t0: [16:13:00 27/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.6 rs: Final st: NotStopd t0: [16:13:00 27/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [16:13:00 27/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [16:13:00 27/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 38 u1: mmHg rs: Final st: NotStopd t0: [16:13:00 27/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 154 u1: mmHg rs: Final st: NotStopd t0: [16:13:00 27/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.4 rs: Final st: NotStopd t0: [16:13:00 27/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.6 rs: Final st: NotStopd t0: [16:13:00 27/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [16:00:00 27/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 27/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 27/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 27/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Altered LOC st: NotStopd t0: [16:00:00 27/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [16:00:00 27/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [16:00:00 27/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [16:00:00 27/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [16:00:00 27/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: ICU Environment st: NotStopd t0: [16:00:00 27/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 27/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 27/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples st: NotStopd t0: [16:00:00 27/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 27/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 27/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 27/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 27/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 27/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 27/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 27/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 27/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 27/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [16:00:00 27/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 27/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd
t0: [17:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [17:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [17:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [17:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0.75 vu: ml
t0: [17:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [17:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [17:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [17:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [17:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [17:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 25 su: ml rt: IV Drip t0: [17:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:00:00 27/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vu: ml
t0: [18:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [18:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [18:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [18:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [18:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [18:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [18:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [18:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [18:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0.75 vu: ml
tf: [10:00:00 31/12/2015] pt: IV Piggyback rt: IV fr: INFUSION m1: Amiodarone HCl v1: 600 u1: mg m2: D5W (EXCEL BAG) v2: 250 u2: ml
t0: [19:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [19:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [19:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [19:00:00 27/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 500 vu: ml t0: [19:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [14:00:00 27/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 27/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 27/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [14:00:00 27/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [14:00:00 27/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 27/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [14:00:00 27/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 27/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 27/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 27/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [14:00:00 27/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [14:00:00 27/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 27/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [14:00:00 27/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [14:00:00 27/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 27/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 27/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 27/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [14:00:00 27/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [14:00:00 27/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [14:00:00 27/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [14:00:00 27/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 27/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 27/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [14:00:00 27/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [14:00:00 27/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [14:00:00 27/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [14:00:00 27/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [14:00:00 27/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [14:00:00 27/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [14:00:00 27/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 27/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 27/12/2015] id: Vent Sens/Capture el: 0 cu: CSRU cg: RN v1: No v2: No st: NotStopd t0: [14:00:00 27/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 27/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [14:00:00 27/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [14:00:00 27/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 27/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 27/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [14:00:00 27/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd
t0: [16:00:00 27/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [16:00:00 27/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [16:00:00 27/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 27/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [16:00:00 27/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [16:00:00 27/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [19:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [19:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [19:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [19:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [19:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [19:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [19:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:30:00 27/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.1935 u1: ml/cmH st: NotStopd t0: [18:30:00 27/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [18:30:00 27/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [18:30:00 27/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [18:30:00 27/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [18:30:00 27/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [18:30:00 27/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:1.9 st: NotStopd t0: [18:30:00 27/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [18:30:00 27/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [18:30:00 27/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [18:30:00 27/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [18:30:00 27/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [18:30:00 27/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [18:30:00 27/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [18:30:00 27/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [18:30:00 27/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 15.2 u1: L/min st: NotStopd t0: [18:30:00 27/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [18:30:00 27/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [18:30:00 27/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [18:30:00 27/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [18:30:00 27/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [18:30:00 27/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [18:30:00 27/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [18:30:00 27/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [18:30:00 27/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [18:30:00 27/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [18:30:00 27/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [18:30:00 27/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [18:30:00 27/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [18:30:00 27/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [18:03:00 27/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 54 rs: Final st: NotStopd t0: [18:03:00 27/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 54 rs: Final st: NotStopd
t0: [21:00:00 27/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [21:00:00 27/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [21:00:00 27/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [21:00:00 27/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [21:00:00 27/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [21:00:00 27/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [21:00:00 27/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1.5 st: NotStopd t0: [21:00:00 27/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [21:00:00 27/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [21:00:00 27/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [21:00:00 27/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [21:00:00 27/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [21:00:00 27/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [21:00:00 27/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [21:00:00 27/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [21:00:00 27/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.8 u1: L/min st: NotStopd t0: [21:00:00 27/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [21:00:00 27/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [21:00:00 27/12/2015] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [21:00:00 27/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [21:00:00 27/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [21:00:00 27/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [21:00:00 27/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [21:00:00 27/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [21:00:00 27/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [21:00:00 27/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [21:00:00 27/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White v2: Thick st: NotStopd t0: [21:00:00 27/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [21:00:00 27/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 487 u1: ml/B st: NotStopd t0: [21:00:00 27/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [21:00:00 27/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [21:00:00 27/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [21:00:00 27/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 27/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 27/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 27/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 27/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 27/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 27/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 27/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 27/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 27/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 27/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 27/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 27/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 27/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 27/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 27/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 27/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 27/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 27/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 27/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 27/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 27/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Altered LOC st: NotStopd t0: [20:00:00 27/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [20:00:00 27/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [20:00:00 27/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [20:00:00 27/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [20:00:00 27/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: ICU Environment st: NotStopd t0: [20:00:00 27/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 27/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 27/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 27/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 27/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 27/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 27/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 27/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 27/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [20:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 27/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 27/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 27/12/2015] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 27/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 27/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 27/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples st: NotStopd t0: [20:00:00 27/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 27/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 27/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 27/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 27/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 27/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Bronchial st: NotStopd t0: [20:00:00 27/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [20:00:00 27/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [20:00:00 27/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 27/12/2015] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [20:00:00 27/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 27/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 2 st: NotStopd t0: [20:00:00 27/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [20:00:00 27/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [20:00:00 27/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [20:00:00 27/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [20:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 119 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [20:00:00 27/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [20:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [20:00:00 27/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 27/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [20:00:00 27/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [20:00:00 27/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [20:00:00 27/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 27/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 27/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [20:00:00 27/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 27/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 27/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 27/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 27/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 27/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 27/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 27/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:00:00 27/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.5556 u1: Deg. C st: NotStopd t0: [20:00:00 27/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96 u1: Deg. F st: NotStopd t0: [20:00:00 27/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Amber v2: Clear st: NotStopd t0: [20:00:00 27/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 27/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 27/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Apprehensive st: NotStopd t0: [20:00:00 27/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [20:00:00 27/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 27/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 27/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 27/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 27/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 27/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 14 u1: number st: NotStopd t0: [20:00:00 27/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 27/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 27/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [20:00:00 27/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 27/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 27/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 27/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 27/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [21:00:00 27/12/2015] id: Pain Level el: 0 cu: CSRU cg: RN v1: 6-Mod to Severe st: NotStopd t0: [21:00:00 27/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 27/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [21:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 27/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [21:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 79 u1: BPM st: NotStopd t0: [21:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 143 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [21:00:00 27/12/2015] id: Pain Cause el: 0 cu: CSRU cg: RN v1: At Rest st: NotStopd t0: [21:00:00 27/12/2015] id: Pain Level (Rest) el: 0 cu: CSRU cg: RN v1: 6-Mod to Severe st: NotStopd t0: [21:00:00 27/12/2015] id: Pain Location el: 0 cu: CSRU cg: RN v1: Incisional st: NotStopd t0: [21:00:00 27/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push v2: Repositioned st: NotStopd t0: [21:00:00 27/12/2015] id: Pain Type el: 0 cu: CSRU cg: RN v1: Constant st: NotStopd t0: [21:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [21:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [21:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 27/12/2015] id: Pain Level/Response el: 0 cu: CSRU cg: RN v1: 2-Mild st: NotStopd t0: [22:00:00 27/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [22:00:00 27/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd
t0: [20:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [20:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [20:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [20:00:00 27/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 110 vu: ml t0: [20:00:00 27/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [20:00:00 27/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 80 vu: ml t0: [20:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml t0: [20:00:00 27/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [21:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [21:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [21:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [21:00:00 27/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [21:00:00 27/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [21:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [20:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [20:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [21:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [21:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 27/12/2015] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 60 ap: none
t0: [15:21:00 27/12/2015] id: Vancomycin/Random Drug Level el: 0 cu: CSRU cg: 3161 v1: 29.2 rs: Final st: NotStopd
t0: [21:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Agitated st: NotStopd t0: [22:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 94 u1: BPM st: NotStopd t0: [22:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 151 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [22:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [22:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [22:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [22:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 27/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 27/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 27/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [23:00:00 27/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 27/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 27/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [23:00:00 27/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 27/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [23:00:00 27/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [23:00:00 27/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 27/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [23:00:00 27/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [23:00:00 27/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 28/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 28/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [00:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [00:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [00:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [00:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [00:00:00 28/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [00:00:00 28/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [00:00:00 28/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [00:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 27/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [22:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [22:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [22:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [22:00:00 27/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [22:00:00 27/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 70 vu: ml t0: [22:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml t0: [23:00:00 27/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [23:00:00 27/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [23:00:00 27/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [23:00:00 27/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [23:00:00 27/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 60 vu: ml t0: [23:00:00 27/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml t0: [00:00:00 28/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [00:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [00:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [00:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [00:00:00 28/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 80 vu: ml t0: [00:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [00:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [00:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml t0: [00:00:00 28/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [22:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [22:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [23:00:00 27/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 27/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [23:00:00 27/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [00:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [00:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 28/12/2015] dt: 24 id: Drain #1 Total Out el: 3 cu: CSRU cg: RN cv: 430 ap: none
t0: [23:00:00 27/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vu: ml
t0: [01:00:00 28/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [01:00:00 28/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [01:00:00 28/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [01:00:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [01:00:00 28/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [01:00:00 28/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [01:00:00 28/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1.5 st: NotStopd t0: [01:00:00 28/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [01:00:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [01:00:00 28/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [01:00:00 28/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 28/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [01:00:00 28/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [01:00:00 28/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [01:00:00 28/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [01:00:00 28/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.1 u1: L/min st: NotStopd t0: [01:00:00 28/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 28/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 28/12/2015] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [01:00:00 28/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [01:00:00 28/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [01:00:00 28/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [01:00:00 28/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [01:00:00 28/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [01:00:00 28/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [01:00:00 28/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [01:00:00 28/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [01:00:00 28/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [01:00:00 28/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 462 u1: ml/B st: NotStopd t0: [01:00:00 28/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [01:00:00 28/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 50 u1: ml/B st: NotStopd t0: [01:00:00 28/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [01:00:00 28/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [01:00:00 28/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [01:16:00 28/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 50.1 rs: Final st: NotStopd t0: [01:16:00 28/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 50.1 rs: Final st: NotStopd
t0: [20:00:00 27/12/2015] id: Chest PT R/L el: 0 cu: CSRU cg: RN v1: Done v2: Done st: NotStopd t0: [20:00:00 27/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 27/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 27/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 27/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [20:00:00 27/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 27/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 27/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [20:00:00 27/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 27/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 27/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 27/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [20:00:00 27/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [20:00:00 27/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 27/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 27/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 27/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 27/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 27/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 27/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 27/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 27/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 27/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 27/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 27/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [22:00:00 27/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 27/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 27/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 27/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 27/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [22:00:00 27/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 27/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [22:00:00 27/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [22:00:00 27/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Anxious st: NotStopd t0: [22:00:00 27/12/2015] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 115 rs: Manual st: NotStopd t0: [00:00:00 28/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 28/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 28/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 28/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 28/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 28/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 28/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [00:00:00 28/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 28/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 28/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 28/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 28/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 28/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 28/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 28/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 28/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 28/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 28/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 28/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 28/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 28/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 28/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 28/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 28/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 28/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Not Done st: NotStopd t0: [00:00:00 28/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 28/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 28/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 28/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 28/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 28/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [00:00:00 28/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 28/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 28/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 28/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [00:00:00 28/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 28/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 28/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 28/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [00:00:00 28/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [00:00:00 28/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 28/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 28/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 28/12/2015] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 28/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 28/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 28/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples st: NotStopd t0: [00:00:00 28/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 28/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 28/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 28/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 28/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 28/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Bronchial st: NotStopd t0: [00:00:00 28/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 28/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 28/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 28/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 28/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 28/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 28/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 28/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [00:00:00 28/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [00:00:00 28/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [00:00:00 28/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [00:00:00 28/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [00:00:00 28/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 28/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 28/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 28/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 28/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 28/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [00:00:00 28/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [00:00:00 28/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 28/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 28/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 28/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 28/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 28/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 28/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 28/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 28/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 28/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 28/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 28/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 28/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 28/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 28/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 28/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 28/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [00:00:00 28/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [00:00:00 28/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 28/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [00:00:00 28/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 28/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 28/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 28/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 28/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [01:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [01:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 124 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [01:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [01:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [01:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [01:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [01:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [01:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [01:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [01:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 120 vu: ml t0: [01:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml t0: [02:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [02:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [02:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [02:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [02:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 60 vu: ml t0: [02:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [01:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [01:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 28/12/2015] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 50 cv: 50 ap: none t0: [23:00:00 28/12/2015] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: 117.5 cv: 117.5 ap: none t0: [23:00:00 28/12/2015] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 77.5 cv: 1754 ap: none t0: [23:00:00 28/12/2015] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 167.5 cv: 4734 ap: none t0: [23:00:00 28/12/2015] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 680 ap: none t0: [23:00:00 28/12/2015] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 50 cv: 1040 ap: none t0: [23:00:00 28/12/2015] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: 117.5 cv: 1529 ap: none t0: [23:00:00 28/12/2015] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 50 cv: 3205 ap: none t0: [23:00:00 28/12/2015] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 1735 ap: none t0: [23:00:00 28/12/2015] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: 117.5 cv: 9658.84 ap: carryForward
t0: [23:00:00 27/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [02:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [02:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [02:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [02:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [02:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [02:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [00:00:00 28/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 28/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 28/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [03:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [03:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [03:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [03:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [03:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [03:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [03:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 28/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 28/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 28/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 28/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 28/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [04:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [04:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [04:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [04:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [04:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [04:00:00 28/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [04:00:00 28/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [04:00:00 28/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [04:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [03:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [03:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [03:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [03:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 70 vu: ml t0: [03:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml t0: [04:00:00 28/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [04:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [04:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [04:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [04:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [04:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [04:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [03:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [03:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [04:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 25 su: ml rt: IV Drip t0: [04:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [03:21:00 28/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.2 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 13.2 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 25.5 u1: % rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 7.7 u1: gm/dl rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 277 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 2.85 u1: /mic l rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.2 rs: Final st: NotStopd
t0: [03:21:00 28/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 53 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 84 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.1 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.7 u1: mEq/L rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 136 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 53 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 7.4 u1: mg/dl rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 84 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.1 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.7 u1: mEq/L rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [03:21:00 28/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 136 rs: Final st: NotStopd
t0: [05:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [05:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 109 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [05:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [05:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [05:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [05:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [05:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [05:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [05:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 70 vu: ml t0: [05:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.25 vu: ml
t0: [05:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 25 su: ml rt: IV Drip t0: [05:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:00:00 28/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [05:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vu: ml
t0: [05:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml st: Stopped
t0: [06:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [06:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [06:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [06:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [06:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [06:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 28/12/2015] id: D5W 250.0ml + 32mcgkgmin Levophed-k IV Infusions el: 1 cu: CSRU cg: -1 ai: 210 vo: 0 st: D/C'd
t0: [06:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [05:59:00 28/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd
t0: [05:00:00 28/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.3333 u1: ml/cmH st: NotStopd t0: [05:00:00 28/12/2015] id: RSBI Not Completed el: 0 cu: CSRU cg: RRT v1: Other/Remarks st: NotStopd t0: [05:00:00 28/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [05:00:00 28/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [05:00:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [05:00:00 28/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [05:00:00 28/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [05:00:00 28/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1.5 st: NotStopd t0: [05:00:00 28/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:00:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [05:00:00 28/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [05:00:00 28/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 28/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [05:00:00 28/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:00:00 28/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [05:00:00 28/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [05:00:00 28/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [05:00:00 28/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 28/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 28/12/2015] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [05:00:00 28/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [05:00:00 28/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [05:00:00 28/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [05:00:00 28/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [05:00:00 28/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [05:00:00 28/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [05:00:00 28/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [05:00:00 28/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White st: NotStopd t0: [05:00:00 28/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [05:00:00 28/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 453 u1: ml/B st: NotStopd t0: [05:00:00 28/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [05:00:00 28/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 52 u1: ml/B st: NotStopd t0: [05:00:00 28/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [05:00:00 28/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [05:00:00 28/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [06:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [06:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [06:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [06:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 40 vu: ml t0: [06:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0.75 vu: ml
t0: [07:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [07:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [07:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [07:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [07:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [07:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [07:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [07:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [07:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [06:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip st: NotStopd t0: [06:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 du: mghr sv: 25 su: ml rt: IV Drip st: Stopped t0: [07:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [05:00:00 28/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: RN v1: 7.45 rs: Manual st: NotStopd t0: [05:00:00 28/12/2015] id: CaO2 el: 0 cu: CSRU cg: RN v1: 10.4929 u1: ml/dl st: NotStopd t0: [05:00:00 28/12/2015] id: AaDO2 el: 0 cu: CSRU cg: RN v1: 56.9 u1: mmHg st: NotStopd t0: [05:00:00 28/12/2015] id: PAO2 el: 0 cu: CSRU cg: RN v1: 179.9 u1: mmHg st: NotStopd t0: [05:00:00 28/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: RN v1: 0 rs: Manual st: NotStopd t0: [05:00:00 28/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: RN v1: 24 rs: Manual st: NotStopd t0: [05:00:00 28/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: RN v1: 34 u1: mmHg rs: Manual st: NotStopd t0: [05:00:00 28/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: RN v1: 123 u1: mmHg rs: Manual st: NotStopd t0: [05:00:00 28/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: RN v1: 7.45 rs: Manual st: NotStopd t0: [05:00:00 28/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: RN v1: 98 u1: % rs: Manual st: NotStopd
t0: [06:23:00 28/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 72.6 rs: Final st: NotStopd t0: [06:23:00 28/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 72.6 rs: Final st: NotStopd
t0: [04:00:00 28/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 28/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [04:00:00 28/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 28/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 28/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 28/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [04:00:00 28/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 28/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 28/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [04:00:00 28/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [04:00:00 28/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd
t0: [08:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [08:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [08:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
tf: [15:00:00 28/12/2015] pt: IV Piggyback rt: IV fr: ASDIR m1: Heparin Sodium v1: 25000 u1: UNIT m2: D5W v2: 250 u2: ml
t0: [08:00:00 28/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 28/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 28/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 28/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 28/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 28/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 28/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 28/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [08:00:00 28/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 28/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 28/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 28/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 28/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 28/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 28/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 28/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 28/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 28/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 28/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 28/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 28/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 28/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 28/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Altered LOC st: NotStopd t0: [08:00:00 28/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient/Family st: NotStopd t0: [08:00:00 28/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [08:00:00 28/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 28/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [08:00:00 28/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 28/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 28/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 28/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 28/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 90 degrees st: NotStopd t0: [08:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [08:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 28/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 28/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [08:00:00 28/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 28/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 28/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 28/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 28/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 28/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 28/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [08:00:00 28/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [08:00:00 28/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 28/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 28/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [08:00:00 28/12/2015] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 28/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 28/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 28/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 28/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 28/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 28/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 28/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 28/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 28/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 28/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Bronchial st: NotStopd t0: [08:00:00 28/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 28/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 28/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 28/12/2015] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [08:00:00 28/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 28/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 28/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 28/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [08:00:00 28/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [08:00:00 28/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [08:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [08:00:00 28/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [08:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [08:00:00 28/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [08:00:00 28/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 28/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 28/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 28/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [08:00:00 28/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [08:00:00 28/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 28/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 28/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 28/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [08:00:00 28/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 28/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 28/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 28/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 28/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [08:00:00 28/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 28/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 28/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [08:00:00 28/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [08:00:00 28/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [08:00:00 28/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 28/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [08:00:00 28/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 28/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 28/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 28/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 28/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 28/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 14 u1: number st: NotStopd t0: [08:00:00 28/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 28/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 28/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 28/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 28/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 28/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 28/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd
t0: [08:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 110 vu: ml t0: [08:00:00 28/12/2015] tf: [20:00:00 29/12/2015] dt: 2160 id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 115 vu: ml
t0: [08:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:30:00 28/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.3333 u1: ml/cmH st: NotStopd t0: [08:30:00 28/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [08:30:00 28/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:30:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:30:00 28/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [08:30:00 28/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [08:30:00 28/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:1.6 st: NotStopd t0: [08:30:00 28/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:30:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:30:00 28/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [08:30:00 28/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:30:00 28/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [08:30:00 28/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:30:00 28/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:30:00 28/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [08:30:00 28/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [08:30:00 28/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:30:00 28/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:30:00 28/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [08:30:00 28/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [08:30:00 28/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:30:00 28/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [08:30:00 28/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [08:30:00 28/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [08:30:00 28/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:30:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 92 u1: % st: NotStopd t0: [08:30:00 28/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT st: NotStopd t0: [08:30:00 28/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: None st: NotStopd t0: [08:30:00 28/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:30:00 28/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:30:00 28/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [08:30:00 28/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [08:30:00 28/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [08:45:00 28/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.41 rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 10.5177 u1: ml/dl st: NotStopd t0: [08:45:00 28/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 100 rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.4 rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 38 u1: mmHg rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 131 u1: mmHg rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.41 rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 100 rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 0.81 rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.4 rs: Final st: NotStopd t0: [08:45:00 28/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [09:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 59 u1: BPM st: NotStopd t0: [09:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [09:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [09:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [09:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [09:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [09:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 94 u1: % st: NotStopd t0: [09:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [09:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [09:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [09:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 28/12/2015] tf: [14:15:00 28/12/2015] dt: 315 id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 7 du: mghr sv: 25 su: ml rt: IV Drip t0: [09:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:00:00 28/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [09:00:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [09:00:00 28/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [09:00:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [09:00:00 28/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [09:00:00 28/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [09:00:00 28/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [09:00:00 28/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [09:00:00 28/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [09:00:00 28/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [09:00:00 28/12/2015] id: Radiologic Study el: 0 cu: CSRU cg: RN v1: Chest Xray st: NotStopd t0: [09:15:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:15:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:15:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:15:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:15:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 56 u1: BPM st: NotStopd t0: [09:15:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [09:15:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [09:15:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [09:15:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:15:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [09:15:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [09:15:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:30:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:30:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:30:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 56 u1: BPM st: NotStopd t0: [09:30:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [09:30:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [09:30:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:30:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [09:30:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [09:30:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:15:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [09:15:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 7 du: mghr sv: 25 su: ml rt: IV Drip t0: [09:15:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [09:30:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [09:30:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 7 du: mghr sv: 25 su: ml rt: IV Drip t0: [09:30:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:15:00 28/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [09:15:00 28/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [09:15:00 28/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [09:15:00 28/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:15:00 28/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [09:15:00 28/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:15:00 28/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [09:15:00 28/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [09:30:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:30:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd
t0: [09:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0 vu: ml
t0: [08:00:00 28/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [09:45:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:45:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:45:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:45:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:45:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 56 u1: BPM st: NotStopd t0: [09:45:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [09:45:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [09:45:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [09:45:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:45:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [09:45:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 37 u1: BPM st: NotStopd t0: [09:45:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:45:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [09:45:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 7 du: mghr sv: 25 su: ml rt: IV Drip t0: [09:45:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:55:00 28/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd t0: [09:55:00 28/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 10.5053 u1: ml/dl st: NotStopd t0: [09:55:00 28/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -3 rs: Final st: NotStopd t0: [09:55:00 28/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 22 rs: Final st: NotStopd t0: [09:55:00 28/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 39 u1: mmHg rs: Final st: NotStopd t0: [09:55:00 28/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 127 u1: mmHg rs: Final st: NotStopd t0: [09:55:00 28/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd t0: [09:55:00 28/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [10:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 57 u1: BPM st: NotStopd t0: [10:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [10:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [10:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [10:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [10:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 47 u1: BPM st: NotStopd t0: [10:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [10:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [10:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [10:00:00 28/12/2015] tf: [16:00:00 28/12/2015] dt: 360 id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.75 vu: ml t0: [10:00:00 28/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 150 vu: ml
t0: [10:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 7 du: mghr sv: 25 su: ml rt: IV Drip t0: [10:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [10:30:00 28/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [10:30:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RN v1: 0.3 u1: torr st: NotStopd t0: [10:30:00 28/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [10:30:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [10:30:00 28/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd
t0: [11:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 58 u1: BPM st: NotStopd t0: [11:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [11:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [11:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [11:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [11:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [11:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [11:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [11:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.75 vu: ml
t0: [11:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 7 du: mghr sv: 25 su: ml rt: IV Drip t0: [11:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [10:30:00 28/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.6 u1: L/min st: NotStopd t0: [10:30:00 28/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [10:30:00 28/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 25 u1: . st: NotStopd t0: [10:30:00 28/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [10:30:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 98 u1: % st: NotStopd t0: [10:30:00 28/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 323 u1: ml/B st: NotStopd t0: [10:30:00 28/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: CPAP+PS st: NotStopd t0: [10:30:00 28/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [11:25:00 28/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.26 rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 10.3464 u1: ml/dl st: NotStopd t0: [11:25:00 28/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 96 rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.2 rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -4 rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 50 u1: mmHg rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 109 u1: mmHg rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.26 rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 96 rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.02 rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.2 rs: Final st: NotStopd t0: [11:25:00 28/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 97 u1: % rs: Final st: NotStopd
t0: [12:00:00 28/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 28/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 28/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 28/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 20 u1: . st: NotStopd t0: [12:00:00 28/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [12:00:00 28/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:00:00 28/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 28/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 28/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [08:00:00 28/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 28/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 28/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 28/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 28/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 28/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 28/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [08:00:00 28/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [08:00:00 28/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [08:00:00 28/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 28/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 28/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [09:00:00 28/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Called st: NotStopd t0: [09:00:00 28/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 28/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 28/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 28/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 28/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 28/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [12:00:00 28/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [12:00:00 28/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 28/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 28/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 28/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v2: Negative st: NotStopd t0: [12:00:00 28/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 28/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [12:00:00 28/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 28/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 28/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 28/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 28/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 28/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 28/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [12:00:00 28/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 28/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 28/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 28/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 28/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 28/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 28/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 28/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 28/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 28/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 28/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 28/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [12:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 28/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [12:00:00 28/12/2015] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [12:00:00 28/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 28/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 28/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 28/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 28/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 28/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 28/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [12:00:00 28/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 28/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 28/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 28/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 28/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 28/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 28/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [12:00:00 28/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 28/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 28/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [12:00:00 28/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [12:00:00 28/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [12:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [12:00:00 28/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [12:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [12:00:00 28/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 28/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [12:00:00 28/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [12:00:00 28/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 28/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 28/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 28/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 43 u1: BPM st: NotStopd t0: [12:00:00 28/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 28/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 28/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 28/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 28/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 95 u1: % st: NotStopd t0: [12:00:00 28/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [12:00:00 28/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 28/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 28/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [12:00:00 28/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [12:00:00 28/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 28/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 28/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 28/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Appropriate st: NotStopd t0: [12:00:00 28/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [12:00:00 28/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 28/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [12:00:00 28/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 28/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 28/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 28/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 28/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd
t0: [12:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [12:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [12:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [12:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.75 vu: ml t0: [12:00:00 28/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 140 vu: ml
t0: [12:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 7 du: mghr sv: 25 su: ml rt: IV Drip t0: [12:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 28/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 28/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 28/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [12:00:00 28/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [12:00:00 28/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 28/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 28/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [12:00:00 28/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [12:00:00 28/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 28/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 28/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [12:00:00 28/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [12:00:00 28/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 28/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 28/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [12:00:00 28/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 28/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 28/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [12:00:00 28/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 28/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [12:00:00 28/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 28/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [12:00:00 28/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:30:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:30:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:30:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:30:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:30:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:30:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RN v1: 0.3 u1: torr st: NotStopd t0: [12:30:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 64 u1: BPM st: NotStopd t0: [12:30:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:30:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [12:30:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [12:30:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [12:30:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:30:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [12:30:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [12:30:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 0 vu: ml
t0: [12:30:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [12:30:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [12:30:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:51:00 28/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.24 rs: Final st: NotStopd t0: [12:51:00 28/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -6 rs: Final st: NotStopd t0: [12:51:00 28/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 22 rs: Final st: NotStopd t0: [12:51:00 28/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 49 u1: mmHg rs: Final st: NotStopd t0: [12:51:00 28/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 110 u1: mmHg rs: Final st: NotStopd t0: [12:51:00 28/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.24 rs: Final st: NotStopd
t0: [12:51:00 28/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 10.2463 u1: ml/dl st: NotStopd t0: [12:51:00 28/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 96 u1: % rs: Final st: NotStopd
t0: [13:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 28/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [13:00:00 28/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [13:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [13:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [13:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [13:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [13:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 90 u1: % st: NotStopd t0: [13:00:00 28/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [13:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [13:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [13:00:00 28/12/2015] tf: [09:00:00 30/12/2015] dt: 2640 id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [13:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [13:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.125 vu: ml
t0: [13:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [13:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:51:00 28/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [12:51:00 28/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:51:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:51:00 28/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:51:00 28/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:51:00 28/12/2015] id: AaDO2 el: 0 cu: CSRU cg: RRT v1: 54.9 u1: mmHg st: NotStopd t0: [12:51:00 28/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:51:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [12:51:00 28/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [12:51:00 28/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:51:00 28/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [12:51:00 28/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:51:00 28/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.7 u1: L/min st: NotStopd t0: [12:51:00 28/12/2015] id: PAO2 el: 0 cu: CSRU cg: RRT v1: 164.9 u1: mmHg st: NotStopd t0: [12:51:00 28/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:51:00 28/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [12:51:00 28/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 20 u1: . st: NotStopd t0: [12:51:00 28/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [12:51:00 28/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [12:51:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 94 u1: % st: NotStopd t0: [12:51:00 28/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 280 u1: ml/B st: NotStopd t0: [12:51:00 28/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:51:00 28/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [13:30:00 28/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.6667 u1: ml/cmH st: NotStopd t0: [13:30:00 28/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [13:30:00 28/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [13:30:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [13:30:00 28/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [13:30:00 28/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [13:30:00 28/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:30:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [13:30:00 28/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [13:30:00 28/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [13:30:00 28/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [13:30:00 28/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [13:30:00 28/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [13:30:00 28/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [13:30:00 28/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [13:30:00 28/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:30:00 28/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [13:30:00 28/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [13:30:00 28/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [13:30:00 28/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [13:30:00 28/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [13:30:00 28/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [13:30:00 28/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [13:30:00 28/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [13:30:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 92 u1: % st: NotStopd t0: [13:30:00 28/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [13:30:00 28/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [13:30:00 28/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [13:30:00 28/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [13:30:00 28/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [13:43:00 28/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.39 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -1 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 37 u1: mmHg rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 132 u1: mmHg rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.39 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [14:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [14:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [14:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [14:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [14:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [14:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [14:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [14:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [14:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [14:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [14:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [14:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 2.5 vu: ml t0: [14:00:00 28/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 100 vu: ml
t0: [14:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 25 su: ml rt: IV Drip t0: [14:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:55:00 28/12/2015] id: Blood Products Hematology el: 0 cu: CSRU cg: 3161 v1: Y rs: Final st: NotStopd
id: Packed RBC's el: 1 cu: CSRU cg: RN io: Packed RBC's IV Infusions du: ml rt: Intravenous Push
t0: [13:43:00 28/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.3 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 11.7027 u1: ml/dl st: NotStopd t0: [13:43:00 28/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 13.3 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 28.4 u1: % rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 8.6 u1: gm/dl rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 326 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.14 u1: /mic l rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.3 rs: Final st: NotStopd
t0: [13:43:00 28/12/2015] id: PT el: 0 cu: CSRU cg: 3161 v1: 13.5 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 75.3 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 13.5 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 75.3 rs: Final st: NotStopd
t0: [14:00:00 28/12/2015] id: Procedures el: 0 cu: CSRU cg: RN v1: Cardiac Echo st: NotStopd t0: [14:45:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:45:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:45:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:45:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:45:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 61 u1: BPM st: NotStopd t0: [14:45:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:45:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [14:45:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [14:45:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:45:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [14:45:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [14:45:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [14:45:00 28/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [14:45:00 28/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [14:45:00 28/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [14:45:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:45:00 28/12/2015] tf: [17:00:00 29/12/2015] dt: 1575 id: Packed RBC's IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 375 vu: ml nb: 1
t0: [14:45:00 28/12/2015] tf: [09:53:00 12/01/2016] dt: 21308 id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 du: mghr sv: 25 su: ml rt: IV Drip st: Stopped t0: [14:45:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [14:45:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 25 su: ml rt: IV Drip t0: [14:45:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:43:00 28/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 55 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Albumin Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 9 u1: mg/dl rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 105 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 118 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.1 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.8 u1: mEq/L rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.3 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Total Bili Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: AST Enzymes el: 0 cu: CSRU cg: 3161 v1: 22 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Albumin (>3.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Alk. Phosphate Enzymes el: 0 cu: CSRU cg: 3161 v1: 219 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Amylase Enzymes el: 0 cu: CSRU cg: 3161 v1: 22 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 55 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 9 u1: mg/dl rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 20 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 105 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 118 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: LDH Enzymes el: 0 cu: CSRU cg: 3161 v1: 171 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.1 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.8 u1: mEq/L rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.3 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd t0: [13:43:00 28/12/2015] id: Total Bili (0-1.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd
t0: [15:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 28/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [15:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 60 u1: BPM st: NotStopd t0: [15:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [15:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [15:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [15:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [15:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [15:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [15:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [15:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 1.875 vu: ml
t0: [15:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 25 su: ml rt: IV Drip t0: [15:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [15:10:00 28/12/2015] id: Radiologic Study el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd
t0: [15:00:00 28/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [15:00:00 28/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 28/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 28/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 28/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [15:00:00 28/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 28/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [15:00:00 28/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [16:00:00 28/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 28/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 28/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 28/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 28/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 28/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [16:00:00 28/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 28/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 28/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 28/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 28/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 28/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [16:00:00 28/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 28/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 28/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 28/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 28/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 28/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 28/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [16:00:00 28/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 28/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 28/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Altered LOC st: NotStopd t0: [16:00:00 28/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient/Family st: NotStopd t0: [16:00:00 28/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [16:00:00 28/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [16:00:00 28/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [16:00:00 28/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [16:00:00 28/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 28/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 28/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 28/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 28/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 28/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Not Done st: NotStopd t0: [16:00:00 28/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 28/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 28/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 28/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [16:00:00 28/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [16:00:00 28/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 28/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 28/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [16:00:00 28/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [16:00:00 28/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 28/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [16:00:00 28/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 28/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [16:00:00 28/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [16:00:00 28/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 28/12/2015] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 28/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 28/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 28/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 28/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 28/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 28/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 28/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 28/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 28/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 28/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 28/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [16:00:00 28/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 28/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 28/12/2015] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [16:00:00 28/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [16:00:00 28/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 28/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 28/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [16:00:00 28/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [16:00:00 28/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [16:00:00 28/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [16:00:00 28/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 28/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 28/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [16:00:00 28/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [16:00:00 28/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 28/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 28/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 28/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 28/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 28/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 28/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 28/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 28/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [16:00:00 28/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 28/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 28/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 28/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 28/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [16:00:00 28/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [16:00:00 28/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 28/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 28/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 28/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 28/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 28/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 14 u1: number st: NotStopd t0: [16:00:00 28/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 28/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 28/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [16:00:00 28/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 28/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 28/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [16:00:00 28/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 28/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd
t0: [16:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [16:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [16:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [16:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [16:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0 vu: ml
t0: [16:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 28/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [16:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 28/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 28/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 57 u1: BPM st: NotStopd t0: [16:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [16:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [16:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [16:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [16:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 36 u1: BPM st: NotStopd t0: [16:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [16:00:00 28/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 28/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [16:00:00 28/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [16:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 28/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 250 vu: ml t0: [16:00:00 28/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [16:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 25 su: ml rt: IV Drip t0: [16:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 28/12/2015] id: Packed RBC's IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 375 vu: ml nb: 1
t0: [23:00:00 28/12/2015] dt: 24 id: Blood Products Total el: 3 cu: CSRU cg: RN cv: 750 ap: none
tf: [17:00:00 01/01/2016] pt: IV Piggyback rt: IV fr: ASDIR m1: Heparin Sodium v1: 25000 u1: UNIT m2: D5W v2: 250 u2: ml
t0: [16:32:00 28/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.38 rs: Final st: NotStopd t0: [16:32:00 28/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -4 rs: Final st: NotStopd t0: [16:32:00 28/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 20 rs: Final st: NotStopd t0: [16:32:00 28/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 33 u1: mmHg rs: Final st: NotStopd t0: [16:32:00 28/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 138 u1: mmHg rs: Final st: NotStopd t0: [16:32:00 28/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.38 rs: Final st: NotStopd
t0: [16:32:00 28/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 11.7213 u1: ml/dl st: NotStopd t0: [16:32:00 28/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 109 rs: Final st: NotStopd t0: [16:32:00 28/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.1 rs: Final st: NotStopd t0: [16:32:00 28/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 109 rs: Final st: NotStopd t0: [16:32:00 28/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.05 rs: Final st: NotStopd t0: [16:32:00 28/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.1 rs: Final st: NotStopd t0: [16:32:00 28/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [14:00:00 28/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [14:00:00 28/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [16:00:00 28/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [16:00:00 28/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [17:03:00 28/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.75 u1: ml/cmH st: NotStopd t0: [17:03:00 28/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [17:03:00 28/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [17:03:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [17:03:00 28/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [17:03:00 28/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [17:03:00 28/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:1.7 st: NotStopd t0: [17:03:00 28/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:03:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [17:03:00 28/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:03:00 28/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:03:00 28/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [17:03:00 28/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:03:00 28/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [17:03:00 28/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [17:03:00 28/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 15 u1: L/min st: NotStopd t0: [17:03:00 28/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:03:00 28/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [17:03:00 28/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [17:03:00 28/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [17:03:00 28/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [17:03:00 28/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [17:03:00 28/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [17:03:00 28/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [17:03:00 28/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [17:03:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 92 u1: % st: NotStopd t0: [17:03:00 28/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 438 u1: ml/B st: NotStopd t0: [17:03:00 28/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [17:03:00 28/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [17:03:00 28/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [17:03:00 28/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [13:43:00 28/12/2015] id: Vancomycin/Random Drug Level el: 0 cu: CSRU cg: 3161 v1: 24.4 rs: Final st: NotStopd
t0: [17:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 28/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [17:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 56 u1: BPM st: NotStopd t0: [17:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [17:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [17:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [17:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [17:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [17:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [17:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [17:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [17:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [17:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [17:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0 vu: ml
t0: [17:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 25 su: ml rt: IV Drip t0: [17:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [11:00:00 29/12/2015] pt: Unit Dose rt: IV fr: Q6H fs: 18, 0, 6, 12 dn: 4 m1: Furosemide v1: 40 u1: mg tf: [17:00:00 30/12/2015] pt: Unit Dose rt: IV fr: Q6H fs: 18, 0, 6, 12 dn: 4 m1: Albumin 5% (12.5gm) v1: 12.5 u1: gm
id: Albumin 5% el: 1 cu: CSRU cg: RN io: Albumin 5% IV Infusions du: ml rt: Intravenous Push
t0: [18:00:00 28/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [18:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 56 u1: BPM st: NotStopd t0: [18:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [18:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [18:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [18:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [18:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [18:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 94 u1: % st: NotStopd t0: [18:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 100 vu: ml t0: [18:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [18:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [18:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [18:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [18:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0 vu: ml t0: [18:00:00 28/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 140 vu: ml
t0: [18:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 25 su: ml rt: IV Drip t0: [18:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:00:00 28/12/2015] tf: [09:00:00 01/01/2016] dt: 5220 id: Albumin 5% IV Infusions el: 1 cu: CSRU cg: RN ai: 222 vo: 250 vu: ml
t0: [23:00:00 28/12/2015] dt: 24 id: Colloids Total el: 3 cu: CSRU cg: RN cv: 250 ap: none
t0: [18:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 28/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [18:00:00 28/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd
t0: [18:34:00 28/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.36 rs: Final st: NotStopd t0: [18:34:00 28/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 11.572 u1: ml/dl st: NotStopd t0: [18:34:00 28/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 121 rs: Final st: NotStopd t0: [18:34:00 28/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -4 rs: Final st: NotStopd t0: [18:34:00 28/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 21 rs: Final st: NotStopd t0: [18:34:00 28/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 35 u1: mmHg rs: Final st: NotStopd t0: [18:34:00 28/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 127 u1: mmHg rs: Final st: NotStopd t0: [18:34:00 28/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.36 rs: Final st: NotStopd t0: [18:34:00 28/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 121 rs: Final st: NotStopd t0: [18:34:00 28/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 97 u1: % rs: Final st: NotStopd
t0: [19:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [19:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [19:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [19:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [19:00:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 0 vu: ml
t0: [19:01:00 28/12/2015] id: D5W 25.0ml + 100mghr Lasix IV Infusions el: 1 cu: CSRU cg: -1 ai: 304 vo: 0 st: D/C'd
t0: [19:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 28/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [19:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 57 u1: BPM st: NotStopd t0: [19:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [19:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 117 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [19:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [19:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [19:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 38 u1: BPM st: NotStopd t0: [19:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 94 u1: % st: NotStopd t0: [19:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 28/12/2015] id: Lasix el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 25 su: ml rt: IV Drip t0: [19:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:00:00 28/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 28/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 28/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 28/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 28/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 28/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [04:00:00 28/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 28/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 28/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 28/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 28/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 28/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 28/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 28/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 28/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [04:00:00 28/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 28/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 28/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 28/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 28/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 28/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 28/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 28/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 28/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 28/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 28/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [04:00:00 28/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 28/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 28/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 28/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 28/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 28/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 28/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 28/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 28/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [04:00:00 28/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Lethargic st: NotStopd t0: [04:00:00 28/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 28/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [04:00:00 28/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 28/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 28/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Pacer Turned Off st: NotStopd t0: [04:00:00 28/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [04:00:00 28/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [04:00:00 28/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [04:00:00 28/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [04:00:00 28/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 28/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 28/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 28/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [04:00:00 28/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [04:00:00 28/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [04:00:00 28/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 28/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 28/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 28/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 28/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 28/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 28/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 28/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 28/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 28/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Amber v2: Clear st: NotStopd t0: [04:00:00 28/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 28/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 28/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Withdrawn st: NotStopd t0: [04:00:00 28/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [04:00:00 28/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 28/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [04:00:00 28/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 28/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 28/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 28/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 28/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd
t0: [20:00:00 28/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 28/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RN v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 28/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RN v1: 1:2.0 st: NotStopd t0: [20:00:00 28/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [20:00:00 28/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [20:00:00 28/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [20:00:00 28/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RN v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 28/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RN v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 28/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RN v1: 12.4 u1: L/min st: NotStopd t0: [20:00:00 28/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RN v1: 38 u1: cmH2O st: NotStopd t0: [20:00:00 28/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RN v1: 15 u1: BPM st: NotStopd t0: [20:00:00 28/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RN v1: 37 u1: BPM st: NotStopd t0: [20:00:00 28/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [20:00:00 28/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 28/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 28/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RN v1: 356 u1: ml/B st: NotStopd t0: [20:00:00 28/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RN v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 28/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RN v1: SIMV+PS st: NotStopd t0: [20:00:00 28/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [20:00:00 28/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RN v1: RAMP st: NotStopd
t0: [20:00:00 28/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.3333 u1: ml/cmH st: NotStopd t0: [20:00:00 28/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [20:00:00 28/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 28/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 28/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 28/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 28/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [20:00:00 28/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 28/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 28/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [20:00:00 28/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:00:00 28/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd
t0: [20:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 28/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 23 u1: mmHg st: NotStopd t0: [20:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Agitated st: NotStopd t0: [20:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 28/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 28/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 61 u1: BPM st: NotStopd t0: [20:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 147 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [20:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [20:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [20:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [20:00:00 28/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:00:00 28/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [20:00:00 28/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [20:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [20:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [20:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [20:00:00 28/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 100 vu: ml t0: [20:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [20:00:00 28/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vu: ml t0: [20:00:00 28/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 120 vu: ml
t0: [20:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [21:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 28/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 22 u1: mmHg st: NotStopd t0: [21:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Agitated st: NotStopd t0: [21:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [21:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 162 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [21:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [21:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [21:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 36 u1: BPM st: NotStopd t0: [21:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [21:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 28/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [22:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 56 u1: BPM st: NotStopd t0: [22:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [22:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [22:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [22:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [22:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [22:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [21:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [21:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [21:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [22:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [22:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [22:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [22:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [21:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [22:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 28/12/2015] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 100 ap: none
t0: [20:00:00 28/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 28/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 28/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 28/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 28/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 28/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [20:00:00 28/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 28/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 28/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 28/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 28/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 28/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 28/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 28/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 28/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 28/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 28/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 28/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 28/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 28/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Anxiety st: NotStopd t0: [20:00:00 28/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient/Family st: NotStopd t0: [20:00:00 28/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [20:00:00 28/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [20:00:00 28/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [20:00:00 28/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 28/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 28/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 28/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 28/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 28/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 28/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 28/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 28/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 28/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 28/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 28/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 28/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [20:00:00 28/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 28/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 28/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 28/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 28/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 28/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [20:00:00 28/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 28/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [20:00:00 28/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [20:00:00 28/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 28/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: Bleeding st: NotStopd t0: [20:00:00 28/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [20:00:00 28/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 28/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 28/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 28/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 28/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 28/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 28/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 28/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 28/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 28/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [20:00:00 28/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [20:00:00 28/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [20:00:00 28/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 28/12/2015] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [20:00:00 28/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [20:00:00 28/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 28/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 28/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 28/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [20:00:00 28/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [20:00:00 28/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [20:00:00 28/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [20:00:00 28/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 28/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 28/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 28/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 28/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [20:00:00 28/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [20:00:00 28/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 28/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 28/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 28/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 28/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 28/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 28/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 28/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 28/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 28/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Amber v2: Clear st: NotStopd t0: [20:00:00 28/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 28/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 28/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Anxious st: NotStopd t0: [20:00:00 28/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 28/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 28/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 28/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 28/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 28/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 28/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [20:00:00 28/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 28/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 28/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [20:00:00 28/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 28/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 28/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [20:00:00 28/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 28/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [21:00:00 28/12/2015] id: Pain Level el: 0 cu: CSRU cg: RN v1: 5-Moderate st: NotStopd t0: [21:00:00 28/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 28/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [21:00:00 28/12/2015] id: Pain Cause el: 0 cu: CSRU cg: RN v1: At Rest st: NotStopd t0: [21:00:00 28/12/2015] id: Pain Level (Rest) el: 0 cu: CSRU cg: RN v1: 5-Moderate st: NotStopd t0: [21:00:00 28/12/2015] id: Pain Location el: 0 cu: CSRU cg: RN v1: Incisional st: NotStopd t0: [21:00:00 28/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push v2: Repositioned st: NotStopd t0: [21:00:00 28/12/2015] id: Pain Type el: 0 cu: CSRU cg: RN v1: Constant st: NotStopd t0: [21:14:00 28/12/2015] id: PTT Coags el: 0 cu: CSRU cg: RN v1: 65.4 rs: Final st: NotStopd t0: [21:14:00 28/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: RN v1: 65.4 rs: Final st: NotStopd t0: [22:00:00 28/12/2015] id: Pain Level/Response el: 0 cu: CSRU cg: RN v1: 0-None st: NotStopd t0: [22:00:00 28/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [22:00:00 28/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd
t0: [23:00:00 28/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 28/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 22 u1: mmHg st: NotStopd t0: [23:00:00 28/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 28/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [23:00:00 28/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 28/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 28/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 55 u1: BPM st: NotStopd t0: [23:00:00 28/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [23:00:00 28/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [23:00:00 28/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [23:00:00 28/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [23:00:00 28/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 28/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 28/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 130 vu: ml t0: [23:00:00 28/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 28/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [23:00:00 28/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [23:00:00 28/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [23:00:00 28/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [23:00:00 28/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 28/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [00:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [00:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [00:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [00:00:00 29/12/2015] id: Albumin 5% IV Infusions el: 1 cu: CSRU cg: RN ai: 222 vo: 250 vu: ml t0: [00:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [00:00:00 29/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 250 vu: ml
t0: [23:00:00 29/12/2015] dt: 24 id: Colloids Total el: 3 cu: CSRU cg: RN cv: 750 ap: none
t0: [00:00:00 29/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 12.2222 u1: ml/cmH st: NotStopd t0: [00:00:00 29/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [00:00:00 29/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 29/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 29/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 29/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [00:00:00 29/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 29/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 29/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 29/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 29/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 29/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 29/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 29/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [00:00:00 29/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.7 u1: L/min st: NotStopd t0: [00:00:00 29/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 29/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 29/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 41 u1: cmH2O st: NotStopd t0: [00:00:00 29/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [00:00:00 29/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [00:00:00 29/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [00:00:00 29/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [00:00:00 29/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [00:00:00 29/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 29/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 445 u1: ml/B st: NotStopd t0: [00:00:00 29/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [00:00:00 29/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [00:00:00 29/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 29/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [22:00:00 28/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 28/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 28/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 28/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 28/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 28/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [22:00:00 28/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 28/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [22:00:00 28/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [22:00:00 28/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [22:00:00 28/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [22:00:00 28/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [23:00:00 28/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [00:00:00 29/12/2015] id: Pain Level el: 0 cu: CSRU cg: RN v1: 5-Moderate st: NotStopd t0: [00:00:00 29/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 29/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 22 u1: mmHg st: NotStopd t0: [00:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 29/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 29/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 29/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 29/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 53 u1: BPM st: NotStopd t0: [00:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [00:00:00 29/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 29/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [00:00:00 29/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 29/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 29/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 29/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [00:00:00 29/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 29/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 29/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [00:00:00 29/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [00:00:00 29/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 29/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 29/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 29/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 29/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [00:00:00 29/12/2015] id: Pain Cause el: 0 cu: CSRU cg: RN v1: At Rest st: NotStopd t0: [00:00:00 29/12/2015] id: Pain Level (Rest) el: 0 cu: CSRU cg: RN v1: 5-Moderate st: NotStopd t0: [00:00:00 29/12/2015] id: Pain Location el: 0 cu: CSRU cg: RN v1: Incisional st: NotStopd t0: [00:00:00 29/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push v2: Repositioned st: NotStopd t0: [00:00:00 29/12/2015] id: Pain Type el: 0 cu: CSRU cg: RN v1: Constant st: NotStopd t0: [00:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [00:00:00 29/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [00:00:00 29/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 29/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [00:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [00:00:00 29/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 29/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [00:00:00 29/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [00:00:00 29/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [00:00:00 29/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 29/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:00:00 28/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [22:00:00 28/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [22:00:00 28/12/2015] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 104 rs: Manual st: NotStopd t0: [00:00:00 29/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 29/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 29/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 29/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 29/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 29/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 29/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 29/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 29/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 29/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 29/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 29/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 29/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 29/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 29/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 29/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 29/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 29/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 29/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 29/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 29/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 29/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 29/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Not Done st: NotStopd t0: [00:00:00 29/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 29/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 29/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 29/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 29/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 29/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 29/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 29/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 29/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 29/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 29/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 29/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 29/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 29/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Bronchial st: NotStopd t0: [00:00:00 29/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 29/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 29/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 29/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [00:00:00 29/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 29/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 29/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [00:00:00 29/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [00:00:00 29/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [00:00:00 29/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [00:00:00 29/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 29/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 29/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [00:00:00 29/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 29/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 29/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 29/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 29/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 29/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 29/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 29/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 29/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 29/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 29/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 29/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Amber v2: Clear st: NotStopd t0: [00:00:00 29/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 29/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 29/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [00:00:00 29/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [00:00:00 29/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 29/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [00:00:00 29/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 29/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 29/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [00:00:00 29/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 29/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [01:00:00 29/12/2015] id: Pain Level/Response el: 0 cu: CSRU cg: RN v1: 0-None st: NotStopd t0: [01:00:00 29/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [01:00:00 29/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 25 u1: mmHg st: NotStopd t0: [01:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 57 u1: BPM st: NotStopd t0: [01:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [01:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 116 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [01:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [01:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [01:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [01:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 23 u1: mmHg st: NotStopd t0: [02:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 29/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [02:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 56 u1: BPM st: NotStopd t0: [02:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [02:00:00 29/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [02:00:00 29/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [02:00:00 29/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [02:00:00 29/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [02:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [02:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [02:00:00 29/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [02:00:00 29/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [02:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 29/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [02:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [02:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [02:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 29/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [02:00:00 29/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [02:00:00 29/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [02:00:00 29/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [02:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 28/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [00:00:00 29/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [00:00:00 29/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 80 vu: ml t0: [01:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [01:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [01:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [01:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [02:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [02:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [02:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [02:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [02:00:00 29/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 90 vu: ml
t0: [01:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [02:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 29/12/2015] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 150 cv: 150 ap: none t0: [23:00:00 29/12/2015] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -44.5 cv: -44.5 ap: none t0: [23:00:00 29/12/2015] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 27.5 cv: 1310 ap: none t0: [23:00:00 29/12/2015] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 105.5 cv: 4400 ap: none t0: [23:00:00 29/12/2015] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 300 ap: none t0: [23:00:00 29/12/2015] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 960 ap: none t0: [23:00:00 29/12/2015] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 150 cv: 2310 ap: none t0: [23:00:00 29/12/2015] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -44.5 cv: 736 ap: carryForward t0: [23:00:00 29/12/2015] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 150 cv: 3664 ap: carryForward t0: [23:00:00 29/12/2015] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 974 ap: none t0: [23:00:00 29/12/2015] dt: 24 id: Drain #1 Total Out el: 3 cu: CSRU cg: RN cv: 380 ap: none t0: [23:00:00 29/12/2015] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -44.5 cv: 10394.8 ap: carryForward
t0: [03:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [03:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [03:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 56 u1: BPM st: NotStopd t0: [03:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [03:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [03:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [03:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [03:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [03:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [03:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [03:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [03:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [03:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [03:32:00 29/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.37 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 126 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.9 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -3 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 21 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 35 u1: mmHg rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 126 u1: mmHg rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.37 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 126 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.19 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.9 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [03:28:00 29/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 15.1 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 15.1 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 33.6 u1: % rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.9 u1: gm/dl rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 323 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.8 u1: /mic l rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 15.1 rs: Final st: NotStopd t0: [03:32:00 29/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.7045 u1: ml/dl st: NotStopd
t0: [03:28:00 29/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 57 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 103 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 118 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.9 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 135 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 57 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 19 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 103 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 118 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.9 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 135 rs: Final st: NotStopd
t0: [03:28:00 29/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 61.9 rs: Final st: NotStopd t0: [03:28:00 29/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 61.9 rs: Final st: NotStopd
t0: [17:03:00 28/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 234 u1: ml/B st: NotStopd t0: [20:00:00 28/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 260 u1: ml/B st: NotStopd t0: [04:00:00 29/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.6667 u1: ml/cmH st: NotStopd t0: [04:00:00 29/12/2015] id: RSBI Not Completed el: 0 cu: CSRU cg: RRT v1: Other/Remarks st: NotStopd t0: [04:00:00 29/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [04:00:00 29/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 29/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 29/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 29/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [04:00:00 29/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2 st: NotStopd t0: [04:00:00 29/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 29/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 29/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 29/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 29/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 29/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 29/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 29/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [04:00:00 29/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [04:00:00 29/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 29/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 29/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [04:00:00 29/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [04:00:00 29/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [04:00:00 29/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [04:00:00 29/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [04:00:00 29/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [04:00:00 29/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:00:00 29/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Blood Tinged v2: Frothy st: NotStopd t0: [04:00:00 29/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [04:00:00 29/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 462 u1: ml/B st: NotStopd t0: [04:00:00 29/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [04:00:00 29/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 268 u1: ml/B st: NotStopd t0: [04:00:00 29/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [04:00:00 29/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 29/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 29/12/2015] id: Pain Level el: 0 cu: CSRU cg: RN v1: 5-Moderate st: NotStopd t0: [04:00:00 29/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 29/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 22 u1: mmHg st: NotStopd t0: [04:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 29/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 29/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 58 u1: BPM st: NotStopd t0: [04:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [04:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [04:00:00 29/12/2015] id: Pain Level (Rest) el: 0 cu: CSRU cg: RN v1: 5-Moderate st: NotStopd t0: [04:00:00 29/12/2015] id: Pain Location el: 0 cu: CSRU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 29/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN st: NotStopd t0: [04:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [04:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [04:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [04:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 29/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [04:00:00 29/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [04:00:00 29/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.4 u1: Deg. F st: NotStopd t0: [04:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [04:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [04:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [04:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [04:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 28/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 29/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [02:00:00 29/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 29/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Changed st: NotStopd t0: [04:00:00 29/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 29/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 29/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 29/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 29/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 29/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 29/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Changed st: NotStopd t0: [04:00:00 29/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 29/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 29/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 29/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 29/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 29/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 29/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 29/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [04:00:00 29/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 29/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 29/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 29/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 29/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 29/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 29/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 29/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 29/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 29/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 29/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 29/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 29/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 29/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 29/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [04:00:00 29/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 29/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 29/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 29/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [04:00:00 29/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 29/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [04:00:00 29/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 29/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [04:00:00 29/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [04:00:00 29/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 29/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 29/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 29/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 29/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 29/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 29/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 29/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 29/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 29/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Changed st: NotStopd t0: [04:00:00 29/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 29/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 29/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [04:00:00 29/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [04:00:00 29/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 29/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 29/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 29/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [04:00:00 29/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 29/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 29/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 29/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [04:00:00 29/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [04:00:00 29/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [04:00:00 29/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [04:00:00 29/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [04:00:00 29/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 29/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 29/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 29/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [04:00:00 29/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [04:00:00 29/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [04:00:00 29/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 29/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 29/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 29/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 29/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 29/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 29/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 29/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 29/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 29/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 29/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 29/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Amber v2: Clear st: NotStopd t0: [04:00:00 29/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 29/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 29/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 29/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [04:00:00 29/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [04:00:00 29/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 29/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [04:00:00 29/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Changed st: NotStopd t0: [04:00:00 29/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 29/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [04:00:00 29/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 29/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [05:00:00 29/12/2015] id: Pain Level/Response el: 0 cu: CSRU cg: RN v1: 0-None st: NotStopd t0: [05:00:00 29/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [05:00:00 29/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 25 u1: mmHg st: NotStopd t0: [05:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 61 u1: BPM st: NotStopd t0: [05:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 122 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [05:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [05:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [05:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [05:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 29/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 110 vu: ml t0: [05:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [05:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [05:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [05:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [05:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:00:00 29/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [05:00:00 29/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml
tf: [05:00:00 30/12/2015] pt: Unit Dose rt: IV fr: ONCE MR1 fs: 6 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [06:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [06:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 59 u1: BPM st: NotStopd t0: [06:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Brady st: NotStopd t0: [06:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 117 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [06:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [06:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [06:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [06:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [06:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [06:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [06:00:00 29/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 100 vu: ml
t0: [06:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [03:28:00 29/12/2015] id: Vancomycin/Trough Drug Level el: 0 cu: CSRU cg: 3161 v1: 21.3 rs: Final st: NotStopd
t0: [05:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [06:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [07:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [07:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [07:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 60 u1: BPM st: NotStopd t0: [07:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 127 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [07:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [07:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [07:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [07:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 29/12/2015] id: Albumin 5% IV Infusions el: 1 cu: CSRU cg: RN ai: 222 vo: 250 vu: ml t0: [07:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [07:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [07:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [07:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [07:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 29/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 29/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [08:00:00 29/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 29/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 29/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 29/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 29/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 29/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 29/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [08:00:00 29/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [08:00:00 29/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd
t0: [08:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [08:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [08:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [08:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [08:00:00 29/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 29/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 29/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 29/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 29/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 29/12/2015] id: Pain Level el: 0 cu: CSRU cg: RN v1: 5-Moderate st: NotStopd t0: [08:00:00 29/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 29/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 29/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 29/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 29/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 29/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 29/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 22 u1: mmHg st: NotStopd t0: [08:00:00 29/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 29/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 29/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 29/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 29/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 29/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 29/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [08:00:00 29/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 29/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 29/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 29/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 29/12/2015] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Altered LOC st: NotStopd t0: [08:00:00 29/12/2015] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient/Family st: NotStopd t0: [08:00:00 29/12/2015] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [08:00:00 29/12/2015] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 29/12/2015] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [08:00:00 29/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 29/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 29/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 29/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 29/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 29/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 29/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 29/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 29/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 29/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 61 u1: BPM st: NotStopd t0: [08:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 29/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 29/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 29/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 29/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 29/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 29/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 29/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 29/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 29/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 29/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 29/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 29/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 29/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [08:00:00 29/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 29/12/2015] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: Resp Therapy st: NotStopd t0: [08:00:00 29/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [08:00:00 29/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 29/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 29/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [08:00:00 29/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [08:00:00 29/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: RN v1: 0 st: NotStopd t0: [08:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 129 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [08:00:00 29/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [08:00:00 29/12/2015] id: Pain Level (Rest) el: 0 cu: CSRU cg: RN v1: 5-Moderate st: NotStopd t0: [08:00:00 29/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [08:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [08:00:00 29/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 29/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [08:00:00 29/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [08:00:00 29/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 29/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 29/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 29/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [08:00:00 29/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 29/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 29/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 29/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 29/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 29/12/2015] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [08:00:00 29/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 29/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 29/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [08:00:00 29/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [08:00:00 29/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 29/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 29/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 29/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Anxious st: NotStopd t0: [08:00:00 29/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [08:00:00 29/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 29/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 29/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 29/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 29/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 29/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 14 u1: number st: NotStopd t0: [08:00:00 29/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 29/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 29/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [08:00:00 29/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 29/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 29/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [08:00:00 29/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 29/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd
t0: [08:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 29/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 29/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 29/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 29/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 29/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 29/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 29/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 29/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd
t0: [08:30:00 29/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.75 u1: ml/cmH st: NotStopd t0: [08:30:00 29/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [08:30:00 29/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:30:00 29/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:30:00 29/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:30:00 29/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [08:30:00 29/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.0 st: NotStopd t0: [08:30:00 29/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:30:00 29/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:30:00 29/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:30:00 29/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:30:00 29/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [08:30:00 29/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:30:00 29/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [08:30:00 29/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [08:30:00 29/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [08:30:00 29/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:30:00 29/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:30:00 29/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [08:30:00 29/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:30:00 29/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:30:00 29/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [08:30:00 29/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [08:30:00 29/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [08:30:00 29/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:30:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:30:00 29/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:30:00 29/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:30:00 29/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 60 u1: ml/B st: NotStopd t0: [08:30:00 29/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [08:30:00 29/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [08:30:00 29/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [09:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [09:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 60 u1: BPM st: NotStopd t0: [09:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 129 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [09:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [09:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [09:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [09:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [09:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [09:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [09:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [09:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [10:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [10:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [10:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [10:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [10:00:00 29/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 160 vu: ml
tf: [12:00:00 11/01/2016] pt: Unit Dose rt: NG fr: QD fs: 10 dn: 1 m1: Thiamine HCl v1: 100 u1: mg
t0: [10:00:00 29/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [10:00:00 29/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RN v1: 0.3 u1: torr st: NotStopd t0: [10:00:00 29/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [10:00:00 29/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [10:00:00 29/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [10:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 29/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 29/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd
tf: [13:00:00 03/01/2016] pt: IV Piggyback rt: IV fr: Q8H fs: 2, 10, 18 dn: 3 m1: Piperacillin-Tazobactam Na v1: 2.25 u1: gm m2: Iso-Osmotic Dextrose v2: 50 u2: ml
t0: [11:45:00 29/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.23 rs: Final st: NotStopd t0: [11:45:00 29/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 116 rs: Final st: NotStopd t0: [11:45:00 29/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [11:45:00 29/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -6 rs: Final st: NotStopd t0: [11:45:00 29/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [11:45:00 29/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 52 u1: mmHg rs: Final st: NotStopd t0: [11:45:00 29/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 123 u1: mmHg rs: Final st: NotStopd t0: [11:45:00 29/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.23 rs: Final st: NotStopd t0: [11:45:00 29/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 116 rs: Final st: NotStopd t0: [11:45:00 29/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd
t0: [12:00:00 29/12/2015] id: Pacer Wires Atrial el: 0 cu: CSRU cg: -1 st: D/C'd
tf: [11:00:00 30/12/2015] pt: Unit Dose rt: IV fr: ONCE MR1 fs: 12 dn: 1 m1: Bumetanide v1: 1 u1: mg tf: [08:00:00 01/01/2016] pt: IV Piggyback rt: IV fr: INFUSION m1: Bumetanide v1: 12 u1: mg m2: D5W v2: 500 u2: ml
t0: [10:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [10:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [10:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 138 u1: mmHg v2: 102 u2: mmHg st: NotStopd t0: [10:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [10:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [10:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [11:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [11:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 104 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [11:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [11:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [11:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 29/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 29/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 29/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 29/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 29/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [12:00:00 29/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [12:00:00 29/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 29/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [12:00:00 29/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 29/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 29/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [12:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 29/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 23 u1: mmHg st: NotStopd t0: [12:00:00 29/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 29/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 29/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 29/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 29/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 29/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 29/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 29/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 29/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 29/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 29/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [12:00:00 29/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 29/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 29/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [12:00:00 29/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 29/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 29/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 29/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 29/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 29/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 29/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [12:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 29/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [12:00:00 29/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 29/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [12:00:00 29/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 29/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 29/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 29/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [12:00:00 29/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 29/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [12:00:00 29/12/2015] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 29/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 29/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [12:00:00 29/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [12:00:00 29/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 29/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 29/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 29/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 29/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 29/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 29/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 29/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [12:00:00 29/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 29/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 29/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [12:00:00 29/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 29/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 29/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 29/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [12:00:00 29/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 29/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [12:00:00 29/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [12:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 133 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [12:00:00 29/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [12:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [12:00:00 29/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [12:00:00 29/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 29/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 29/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [12:00:00 29/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 64.8 u1: kg st: NotStopd t0: [12:00:00 29/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [12:00:00 29/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 29/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 29/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [12:00:00 29/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 29/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 29/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 29/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 29/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 29/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 29/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 29/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 29/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2778 u1: Deg. C st: NotStopd t0: [12:00:00 29/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.3 u1: Deg. F st: NotStopd t0: [12:00:00 29/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 29/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 29/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 29/12/2015] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.12318 u1: m2 st: NotStopd t0: [12:00:00 29/12/2015] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.31356 u1: m2 st: NotStopd t0: [12:00:00 29/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 29/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 29/12/2015] id: Weight Change el: 0 cu: CSRU cg: RN v1: 3.1 u1: kg st: NotStopd t0: [12:00:00 29/12/2015] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [12:00:00 29/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Cooperative st: NotStopd t0: [12:00:00 29/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [12:00:00 29/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [12:00:00 29/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [12:00:00 29/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Comp. Immobile st: NotStopd t0: [12:00:00 29/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [12:00:00 29/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [12:00:00 29/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 12 u1: number st: NotStopd t0: [12:00:00 29/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [12:00:00 29/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 29/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [12:00:00 29/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 29/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 29/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 15 cm st: NotStopd t0: [12:00:00 29/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 29/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd
t0: [11:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [11:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [11:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [11:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [12:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [12:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [12:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [12:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml t0: [12:00:00 29/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [12:00:00 29/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 90 vu: ml
t0: [10:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [11:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [12:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 29/12/2015] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden v2: Formed st: NotStopd
t0: [12:00:00 29/12/2015] id: Albumin 5% IV Infusions el: 1 cu: CSRU cg: RN ai: 222 vo: 250 vu: ml
t0: [12:45:00 29/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.25 rs: Final st: NotStopd t0: [12:45:00 29/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -6 rs: Final st: NotStopd t0: [12:45:00 29/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 22 rs: Final st: NotStopd t0: [12:45:00 29/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 48 u1: mmHg rs: Final st: NotStopd t0: [12:45:00 29/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 119 u1: mmHg rs: Final st: NotStopd t0: [12:45:00 29/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.25 rs: Final st: NotStopd
t0: [12:00:00 29/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [12:00:00 29/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 29/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [13:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [13:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 122 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [13:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [13:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [13:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [13:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [13:00:00 29/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [13:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [13:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [13:00:00 29/12/2015] id: R PLEURAL NS IRRIG Free Form Intake el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [13:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:00:00 29/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: .9mg/hr t0: [14:00:00 29/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [14:00:00 29/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [14:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 29/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 29/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 29/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 29/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [14:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [14:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 29/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [14:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 126 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [14:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [14:00:00 29/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [14:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 37 u1: BPM st: NotStopd t0: [14:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 29/12/2015] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden v2: Formed st: NotStopd t0: [14:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 29/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd
t0: [14:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [14:00:00 29/12/2015] tf: [16:00:00 31/12/2015] dt: 3000 id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [14:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [14:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [14:00:00 29/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [14:00:00 29/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 25 vu: ml
t0: [14:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [14:00:00 29/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [14:00:00 29/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [14:00:00 29/12/2015] id: PH el: 0 cu: CSRU cg: RRT v1: 30 t0: [14:00:00 29/12/2015] id: PL el: 0 cu: CSRU cg: RRT v1: 5 t0: [14:00:00 29/12/2015] id: TH el: 0 cu: CSRU cg: RRT v1: 1 t0: [14:00:00 29/12/2015] id: TL el: 0 cu: CSRU cg: RRT v1: 0.4 t0: [14:00:00 29/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [14:00:00 29/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [14:00:00 29/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [14:00:00 29/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [14:00:00 29/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [14:00:00 29/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [14:00:00 29/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [14:00:00 29/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [14:00:00 29/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [14:00:00 29/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [14:00:00 29/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [14:00:00 29/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.08 u1: L/min st: NotStopd t0: [14:00:00 29/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [14:00:00 29/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [14:00:00 29/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [14:00:00 29/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [14:00:00 29/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Other/Remarks st: NotStopd t0: [14:00:00 29/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [23:00:00 29/12/2015] dt: 24 id: Stool Out Total el: 3 cu: CSRU cg: RRT cv: 0 ap: carryForward
t0: [10:00:00 29/12/2015] id: PH el: 0 cu: CSRU cg: RRT v1: 24 t0: [10:00:00 29/12/2015] id: PL el: 0 cu: CSRU cg: RRT v1: 5 t0: [10:00:00 29/12/2015] id: TH el: 0 cu: CSRU cg: RRT v1: 2.5 t0: [10:00:00 29/12/2015] id: TL el: 0 cu: CSRU cg: RRT v1: 0.4
t0: [14:06:00 29/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd t0: [14:06:00 29/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -3 rs: Final st: NotStopd t0: [14:06:00 29/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 22 rs: Final st: NotStopd t0: [14:06:00 29/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 38 u1: mmHg rs: Final st: NotStopd t0: [14:06:00 29/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 129 u1: mmHg rs: Final st: NotStopd t0: [14:06:00 29/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd
t0: [12:00:00 29/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 29/12/2015] id: PH el: 0 cu: CSRU cg: RRT v1: 24 t0: [12:00:00 29/12/2015] id: PL el: 0 cu: CSRU cg: RRT v1: 5 t0: [12:00:00 29/12/2015] id: TH el: 0 cu: CSRU cg: RRT v1: 1.5 t0: [12:00:00 29/12/2015] id: TL el: 0 cu: CSRU cg: RRT v1: 0.4 t0: [12:00:00 29/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 29/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 29/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 29/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 st: NotStopd
t0: [14:00:00 29/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [14:00:00 29/12/2015] id: Pacer Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [14:00:00 29/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [14:00:00 29/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [14:00:00 29/12/2015] id: Vent Sens/Capture el: 0 cu: CSRU cg: RN v1: Yes v2: No st: NotStopd t0: [14:00:00 29/12/2015] id: Vent mA/Sensitivity el: 0 cu: CSRU cg: RN v1: 0 v2: 1.5 st: NotStopd
t0: [15:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [15:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 29/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [15:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 124 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [15:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [15:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [15:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 41 u1: BPM st: NotStopd t0: [15:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [15:00:00 29/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [15:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [15:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [15:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [16:00:00 29/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [16:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [16:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [16:00:00 29/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 29/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 29/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 29/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 29/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 29/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [16:00:00 29/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 29/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [16:00:00 29/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 29/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 29/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [16:00:00 29/12/2015] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 29/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 29/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 29/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 29/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 29/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 29/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 29/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 29/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 29/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 29/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 29/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 29/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 29/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 29/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 29/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 29/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 29/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 29/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 29/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [16:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 29/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [16:00:00 29/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [16:00:00 29/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [16:00:00 29/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 29/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 29/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [16:00:00 29/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [16:00:00 29/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 29/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [16:00:00 29/12/2015] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 29/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 29/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [16:00:00 29/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [16:00:00 29/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [16:00:00 29/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 29/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 29/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 29/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 29/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 29/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 29/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 29/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 29/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 29/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [16:00:00 29/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [16:00:00 29/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 29/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 29/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [16:00:00 29/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 29/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [16:00:00 29/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [16:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 116 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [16:00:00 29/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [16:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [16:00:00 29/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 29/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [16:00:00 29/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Pleural Friction st: NotStopd t0: [16:00:00 29/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [16:00:00 29/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 29/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 29/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 37 u1: BPM st: NotStopd t0: [16:00:00 29/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 29/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 29/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 29/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 29/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 29/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 29/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 29/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 29/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 29/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [16:00:00 29/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [16:00:00 29/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 29/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [16:00:00 29/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 29/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 29/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 29/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 29/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd
t0: [16:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 29/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 29/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [16:00:00 29/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.8 u1: Deg. F st: NotStopd
t0: [16:26:00 29/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.32 rs: Final st: NotStopd t0: [16:26:00 29/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.7789 u1: ml/dl st: NotStopd t0: [16:26:00 29/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 154 rs: Final st: NotStopd t0: [16:26:00 29/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -4 rs: Final st: NotStopd t0: [16:26:00 29/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [16:26:00 29/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 42 u1: mmHg rs: Final st: NotStopd t0: [16:26:00 29/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 150 u1: mmHg rs: Final st: NotStopd t0: [16:26:00 29/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.32 rs: Final st: NotStopd t0: [16:26:00 29/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 154 rs: Final st: NotStopd t0: [16:26:00 29/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.19 rs: Final st: NotStopd t0: [16:26:00 29/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [16:26:00 29/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 3.9 rs: Final st: NotStopd t0: [16:26:00 29/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 3.9 rs: Final st: NotStopd
t0: [16:06:00 29/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 50.7 rs: Final st: NotStopd t0: [16:06:00 29/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 50.7 rs: Final st: NotStopd
t0: [17:00:00 29/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.75 u1: ml/cmH st: NotStopd t0: [17:00:00 29/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [17:00:00 29/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [17:00:00 29/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [17:00:00 29/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [17:00:00 29/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [17:00:00 29/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.0 st: NotStopd t0: [17:00:00 29/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 29/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 29/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [17:00:00 29/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 29/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [17:00:00 29/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 29/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [17:00:00 29/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [17:00:00 29/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [17:00:00 29/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 29/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 29/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [17:00:00 29/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [17:00:00 29/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [17:00:00 29/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [17:00:00 29/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 46 u1: BPM st: NotStopd t0: [17:00:00 29/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [17:00:00 29/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [17:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [17:00:00 29/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 469 u1: ml/B st: NotStopd t0: [17:00:00 29/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [17:00:00 29/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [17:00:00 29/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 29/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [17:00:00 29/12/2015] id: Packed RBC's IV Infusions el: 1 cu: CSRU cg: -1 ai: -1 vo: 0 st: D/C'd
t0: [16:06:00 29/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [16:06:00 29/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd
t0: [17:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [17:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 119 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [17:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [17:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [17:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 50 u1: BPM st: NotStopd t0: [17:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [17:00:00 29/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [17:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [17:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [17:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:46:00 29/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 15.5 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 15.5 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 34.9 u1: % rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 11.1 u1: gm/dl rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 362 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.9 u1: /mic l rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 15.5 rs: Final st: NotStopd
t0: [16:46:00 29/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 55 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 124 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 2 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.1 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 55 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 20 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 124 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.1 rs: Final st: NotStopd t0: [16:46:00 29/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd
t0: [17:00:00 29/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [18:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [18:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 29/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [18:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 150 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [18:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [18:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [18:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [18:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 29/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [18:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [18:00:00 29/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [18:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [18:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [18:00:00 29/12/2015] tf: [20:00:00 29/12/2015] dt: 120 id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [18:00:00 29/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 4 vu: ml
t0: [18:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:00:00 29/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 300 vu: ml
t0: [18:00:00 29/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 29/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [18:00:00 29/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [18:00:00 29/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 29/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [18:00:00 29/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [18:00:00 29/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 29/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [18:00:00 29/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [18:00:00 29/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 29/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [18:00:00 29/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [18:00:00 29/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [18:00:00 29/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [19:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [19:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 154 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [19:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [19:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [19:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 39 u1: BPM st: NotStopd t0: [19:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [19:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [19:00:00 29/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [19:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [19:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [19:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 29/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 29/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 29/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [20:00:00 29/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 29/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 29/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 29/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [20:00:00 29/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 29/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 29/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [20:00:00 29/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Grimace Scale st: NotStopd t0: [20:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 29/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 29/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 29/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 29/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 29/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 29/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 29/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 29/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 29/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 29/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 29/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 29/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 29/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 29/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 29/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 29/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 29/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 29/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 29/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 29/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 29/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 29/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [20:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 29/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 29/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 29/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 29/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [20:00:00 29/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 29/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 29/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 29/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 29/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 29/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 29/12/2015] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 29/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 29/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [20:00:00 29/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [20:00:00 29/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [20:00:00 29/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 29/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 29/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 29/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 29/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 29/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 29/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 29/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 29/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 29/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 29/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 29/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 29/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [20:00:00 29/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 29/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 29/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [20:00:00 29/12/2015] id: Pacer Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [20:00:00 29/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [20:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 141 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [20:00:00 29/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [20:00:00 29/12/2015] id: Pain Location el: 0 cu: CSRU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 29/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push v2: IV Push st: NotStopd t0: [20:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [20:00:00 29/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 29/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 29/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 29/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [20:00:00 29/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 29/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [20:00:00 29/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 29/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 39 u1: BPM st: NotStopd t0: [20:00:00 29/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 29/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 29/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 29/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 29/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [20:00:00 29/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Brown v2: Thick st: NotStopd t0: [20:00:00 29/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [20:00:00 29/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 29/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.8333 u1: Deg. C st: NotStopd t0: [20:00:00 29/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.5 u1: Deg. F st: NotStopd t0: [20:00:00 29/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 29/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 29/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 29/12/2015] id: Vent mA/Sensitivity el: 0 cu: CSRU cg: RN v1: 0 v2: 1.5 st: NotStopd t0: [20:00:00 29/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 29/12/2015] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [20:00:00 29/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 29/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 29/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 29/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 29/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 29/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 29/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 12 u1: number st: NotStopd t0: [20:00:00 29/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 29/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 29/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [20:00:00 29/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 29/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 29/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [20:00:00 29/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 29/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd
t0: [20:00:00 29/12/2015] tf: [13:00:00 30/12/2015] dt: 1020 id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 10 vu: ml t0: [20:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [20:00:00 29/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [20:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [20:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [20:00:00 29/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [20:00:00 29/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [20:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 29/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.3333 u1: ml/cmH st: NotStopd t0: [20:00:00 29/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [20:00:00 29/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 29/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 29/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 29/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2 st: NotStopd t0: [20:00:00 29/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 29/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 29/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [20:00:00 29/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 29/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 29/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 29/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 29/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [20:00:00 29/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.8 u1: L/min st: NotStopd t0: [20:00:00 29/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 29/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 29/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [20:00:00 29/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [20:00:00 29/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:00:00 29/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [20:00:00 29/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [20:00:00 29/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [20:00:00 29/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 29/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 431 u1: ml/B st: NotStopd t0: [20:00:00 29/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 29/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [20:00:00 29/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 29/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [21:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [21:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 29/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [21:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 119 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [21:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [21:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [21:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [21:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 29/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [22:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 29/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [22:00:00 29/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 29/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 29/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 121 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [22:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [22:00:00 29/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [22:00:00 29/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 29/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [22:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [22:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 47 u1: BPM st: NotStopd t0: [22:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 29/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [22:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 29/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 29/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 29/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 29/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 29/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 29/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [23:00:00 29/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 29/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [23:00:00 29/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [23:00:00 29/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [23:00:00 29/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 29/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [23:00:00 29/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 44 u1: BPM st: NotStopd t0: [23:00:00 29/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 29/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [21:00:00 29/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [21:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [21:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [22:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [22:00:00 29/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [22:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [22:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [23:00:00 29/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 29/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [23:00:00 29/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [23:00:00 29/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [23:00:00 29/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [21:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [22:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [23:00:00 29/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 29/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 29/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [22:00:00 29/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Brown v2: Thick st: NotStopd t0: [22:00:00 29/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [00:00:00 30/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 30/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 30/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [00:00:00 30/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 30/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 30/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 30/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [00:00:00 30/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 30/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 30/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [00:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 30/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 30/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 30/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 30/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 30/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 30/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 30/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 30/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 30/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 30/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 30/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 30/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [00:00:00 30/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 30/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 30/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 30/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 30/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 30/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 30/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 30/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 30/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 30/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [00:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 30/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 30/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [00:00:00 30/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 30/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 30/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [00:00:00 30/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 30/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 30/12/2015] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 30/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 30/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [00:00:00 30/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [00:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [00:00:00 30/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 30/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 30/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 30/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 30/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 30/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 30/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 30/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 30/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 30/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 30/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 30/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 30/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [00:00:00 30/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 30/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 30/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 30/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [00:00:00 30/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 30/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 30/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [00:00:00 30/12/2015] id: Pacer Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [00:00:00 30/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [00:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 117 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [00:00:00 30/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [00:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [00:00:00 30/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [00:00:00 30/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 30/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [00:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 30/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [00:00:00 30/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 30/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [00:00:00 30/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 30/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Rhonchi st: NotStopd t0: [00:00:00 30/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 30/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 30/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [00:00:00 30/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 30/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 30/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 30/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 30/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [00:00:00 30/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 30/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [00:00:00 30/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.2 u1: Deg. F st: NotStopd t0: [00:00:00 30/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [00:00:00 30/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 30/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 30/12/2015] id: Vent mA/Sensitivity el: 0 cu: CSRU cg: RN v1: 0 v2: 1.5 st: NotStopd t0: [00:00:00 30/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 30/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [00:00:00 30/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [00:00:00 30/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 30/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 30/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd
t0: [00:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [00:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [00:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [00:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [00:00:00 30/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [00:00:00 30/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [00:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 30/12/2015] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 140 ap: none
t0: [01:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [01:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [01:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 118 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [01:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [01:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [01:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [01:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 30/12/2015] id: Albumin 5% IV Infusions el: 1 cu: CSRU cg: RN ai: 222 vo: 250 vu: ml t0: [01:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [01:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [01:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [01:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [01:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 30/12/2015] dt: 24 id: Colloids Total el: 3 cu: CSRU cg: RN cv: 750 ap: none
t0: [20:00:00 29/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [01:00:00 30/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 11.8919 u1: ml/cmH st: NotStopd t0: [01:00:00 30/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [01:00:00 30/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [01:00:00 30/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [01:00:00 30/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [01:00:00 30/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [01:00:00 30/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [01:00:00 30/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [01:00:00 30/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [01:00:00 30/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 30/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [01:00:00 30/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [01:00:00 30/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [01:00:00 30/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [01:00:00 30/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [01:00:00 30/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 30/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 30/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 42 u1: cmH2O st: NotStopd t0: [01:00:00 30/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [01:00:00 30/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [01:00:00 30/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [01:00:00 30/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [01:00:00 30/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [01:00:00 30/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [01:00:00 30/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 416 u1: ml/B st: NotStopd t0: [01:00:00 30/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [01:00:00 30/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [01:00:00 30/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [01:00:00 30/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [02:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [02:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [02:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 113 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [02:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [02:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [02:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [02:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [02:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [02:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [02:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [02:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [03:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [03:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [03:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [03:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [03:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [03:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [03:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 30/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 10 vu: ml t0: [03:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [03:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [03:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [03:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [03:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 30/12/2015] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 300 cv: 300 ap: none t0: [23:00:00 30/12/2015] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -199.5 cv: -199.5 ap: none t0: [23:00:00 30/12/2015] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 22.5 cv: 1210 ap: none t0: [23:00:00 30/12/2015] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 100.5 cv: 3782 ap: none t0: [23:00:00 30/12/2015] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 760 ap: none t0: [23:00:00 30/12/2015] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 300 cv: 5660 ap: none t0: [23:00:00 30/12/2015] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -199.5 cv: -2318 ap: carryForward t0: [23:00:00 30/12/2015] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 300 cv: 6100 ap: carryForward t0: [23:00:00 30/12/2015] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -199.5 cv: 8076.84 ap: carryForward
t0: [03:37:00 30/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.36 rs: Final st: NotStopd t0: [03:37:00 30/12/2015] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 15.1469 u1: ml/dl st: NotStopd t0: [03:37:00 30/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 122 rs: Final st: NotStopd t0: [03:37:00 30/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [03:37:00 30/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [03:37:00 30/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 40 u1: mmHg rs: Final st: NotStopd t0: [03:37:00 30/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 184 u1: mmHg rs: Final st: NotStopd t0: [03:37:00 30/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.36 rs: Final st: NotStopd t0: [03:37:00 30/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 122 rs: Final st: NotStopd t0: [03:37:00 30/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.17 rs: Final st: NotStopd t0: [03:37:00 30/12/2015] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [04:00:00 30/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 12.9412 u1: ml/cmH st: NotStopd t0: [04:00:00 30/12/2015] id: RSBI Not Completed el: 0 cu: CSRU cg: RRT v1: Other/Remarks st: NotStopd t0: [04:00:00 30/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [04:00:00 30/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 30/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 30/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 30/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [04:00:00 30/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.0 st: NotStopd t0: [04:00:00 30/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 30/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 30/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [04:00:00 30/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 30/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 30/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 30/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 30/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [04:00:00 30/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [04:00:00 30/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 30/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 30/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 39 u1: cmH2O st: NotStopd t0: [04:00:00 30/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [04:00:00 30/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [04:00:00 30/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 11 u1: BPM st: NotStopd t0: [04:00:00 30/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [04:00:00 30/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [04:00:00 30/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:00:00 30/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 452 u1: ml/B st: NotStopd t0: [04:00:00 30/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [04:00:00 30/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 56 u1: ml/B st: NotStopd t0: [04:00:00 30/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [04:00:00 30/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 30/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [03:55:00 30/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 16.2 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 16.2 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 33.9 u1: % rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.9 u1: gm/dl rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 372 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.8 u1: /mic l rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 16.2 rs: Final st: NotStopd
t0: [03:55:00 30/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 52 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Albumin Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 103 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.1 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.3 u1: mEq/L rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Albumin (>3.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 52 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 103 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.1 rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.3 u1: mEq/L rs: Final st: NotStopd t0: [03:55:00 30/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd
t0: [00:00:00 30/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [03:00:00 30/12/2015] id: shampoo el: 0 cu: CSRU cg: RN v1: done t0: [03:00:00 30/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:00:00 30/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [03:00:00 30/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 30/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 30/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:00:00 30/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 30/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [03:00:00 30/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 30/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [03:00:00 30/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:00:00 30/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Logroll st: NotStopd t0: [03:00:00 30/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:37:00 30/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 3.7 rs: Final st: NotStopd t0: [03:37:00 30/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 3.7 rs: Final st: NotStopd t0: [04:00:00 30/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 30/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 30/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [04:00:00 30/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 30/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 30/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [04:00:00 30/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 30/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 30/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [04:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 30/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 30/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 30/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 30/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 30/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 30/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 30/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 30/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 30/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 30/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 30/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [04:00:00 30/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 30/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 6 u1: points st: NotStopd t0: [04:00:00 30/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 30/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 30/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 30/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 30/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 30/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [04:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 30/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 30/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [04:00:00 30/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 30/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 30/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [04:00:00 30/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 30/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [04:00:00 30/12/2015] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 30/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 30/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [04:00:00 30/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [04:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [04:00:00 30/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 30/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 30/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 30/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 30/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 30/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 30/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 30/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 30/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 30/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 30/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 30/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 30/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [04:00:00 30/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Bleeding Gum st: NotStopd t0: [04:00:00 30/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 30/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [04:00:00 30/12/2015] id: Pacer Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [04:00:00 30/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [04:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 133 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [04:00:00 30/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [04:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [04:00:00 30/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [04:00:00 30/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 30/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [04:00:00 30/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 30/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 30/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 30/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 30/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [04:00:00 30/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 30/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 30/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 30/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 30/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 30/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Brown v2: Thick st: NotStopd t0: [04:00:00 30/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 30/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 30/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [04:00:00 30/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [04:00:00 30/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [04:00:00 30/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 30/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 30/12/2015] id: Vent mA/Sensitivity el: 0 cu: CSRU cg: RN v1: 0 v2: 1.5 st: NotStopd t0: [04:00:00 30/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 30/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [04:00:00 30/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [04:00:00 30/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 30/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 30/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [04:00:00 30/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [05:00:00 30/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 30/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [05:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [05:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 140 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [05:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [05:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [05:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [05:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [04:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [04:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [04:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [05:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [05:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [05:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [05:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [05:00:00 30/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [05:00:00 30/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [04:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [05:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [06:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [06:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [06:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 133 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [06:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [06:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [06:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [06:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [06:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [06:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [06:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [06:00:00 30/12/2015] id: Albumin 5% IV Infusions el: 1 cu: CSRU cg: RN ai: 222 vo: 250 vu: ml
t0: [06:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [07:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [07:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [07:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 131 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [07:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [07:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [07:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [07:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [07:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [07:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [07:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [07:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [07:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [11:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [12:30:00 28/12/2015] id: Previous Weight el: 0 cu: CSRU cg: 3161 v1: 64.8 u1: kg st: NotStopd t0: [12:30:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [13:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [15:00:00 28/12/2015] id: Previous Weight el: 0 cu: CSRU cg: 3161 v1: 64.8 u1: kg st: NotStopd t0: [15:00:00 28/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [05:00:00 30/12/2015] id: Previous Weight el: 0 cu: CSRU cg: 3161 v1: 67.9 u1: kg st: NotStopd t0: [06:49:00 30/12/2015] id: PT el: 0 cu: CSRU cg: 3161 v1: 13.8 rs: Final st: NotStopd t0: [06:49:00 30/12/2015] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [06:49:00 30/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 54.8 rs: Final st: NotStopd t0: [06:49:00 30/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [06:49:00 30/12/2015] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 13.8 rs: Final st: NotStopd t0: [06:49:00 30/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 54.8 rs: Final st: NotStopd
id: Gastric Meds el: 1 cu: CSRU cg: RN io: Gastric Meds PO/Gastric du: ml rt: Gastric/Feeding Tube
t0: [08:00:00 30/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 10.7317 u1: ml/cmH st: NotStopd t0: [08:00:00 30/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [08:00:00 30/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 30/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 30/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:00:00 30/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [08:00:00 30/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.0 st: NotStopd t0: [08:00:00 30/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 30/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 30/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [08:00:00 30/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 30/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 30/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 30/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 30/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [08:00:00 30/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [08:00:00 30/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 30/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 30/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 46 u1: cmH2O st: NotStopd t0: [08:00:00 30/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [08:00:00 30/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:00:00 30/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 30/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [08:00:00 30/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [08:00:00 30/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [08:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 98 u1: % st: NotStopd t0: [08:00:00 30/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT st: NotStopd t0: [08:00:00 30/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: None st: NotStopd t0: [08:00:00 30/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 460 u1: ml/B st: NotStopd t0: [08:00:00 30/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:00:00 30/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [08:00:00 30/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 30/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 30/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 30/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 30/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 30/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 30/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 30/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [08:00:00 30/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 30/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 30/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 30/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 30/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 30/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 30/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 30/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 30/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 30/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 30/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 30/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 30/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 30/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 30/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 30/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 30/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 30/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 30/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 30/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 30/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 30/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 30/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [08:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 30/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 30/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [08:00:00 30/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 30/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 30/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 30/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 30/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 30/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 30/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [08:00:00 30/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [08:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [08:00:00 30/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 30/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 30/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 30/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 30/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 30/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 30/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 30/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 30/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [08:00:00 30/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 30/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 30/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 30/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 30/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 30/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [08:00:00 30/12/2015] id: Pacer Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [08:00:00 30/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [08:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 147 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [08:00:00 30/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [08:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [08:00:00 30/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [08:00:00 30/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 30/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 30/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [08:00:00 30/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 30/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 30/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 30/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [08:00:00 30/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 30/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 30/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 30/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 30/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 30/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 30/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [08:00:00 30/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [08:00:00 30/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 30/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 30/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 30/12/2015] id: Vent mA/Sensitivity el: 0 cu: CSRU cg: RN v1: 0 v2: 1.5 st: NotStopd t0: [08:00:00 30/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 30/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 30/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 30/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 30/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 30/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd
t0: [08:00:00 30/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 120 vu: ml t0: [08:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [08:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [08:00:00 30/12/2015] tf: [09:53:00 12/01/2016] dt: 18833 id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 90 vu: ml t0: [08:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [08:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [08:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 30/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 30/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 30/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 30/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 30/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [08:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [09:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 148 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [09:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [09:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [09:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [09:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [10:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 151 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [10:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [10:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [10:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 41 u1: BPM st: NotStopd t0: [10:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [09:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [09:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [09:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 0 vu: ml t0: [10:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [10:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [10:00:00 30/12/2015] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 30 vu: ml t0: [10:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [10:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 0 vu: ml
t0: [09:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [10:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 30/12/2015] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 150 ap: none
t0: [08:00:00 30/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 30/12/2015] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 30/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 30/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 30/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 30/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 30/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [09:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [10:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [11:00:00 30/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [11:00:00 30/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [11:00:00 30/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [11:00:00 30/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [11:00:00 30/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [11:00:00 30/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [11:00:00 30/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [11:00:00 30/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [11:00:00 30/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [11:00:00 30/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [11:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 30/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [11:00:00 30/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [11:00:00 30/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [11:00:00 30/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [11:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 30/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 30/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [11:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 30/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [11:00:00 30/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [11:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 30/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [11:00:00 30/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [11:00:00 30/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [11:00:00 30/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [11:00:00 30/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [11:00:00 30/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [11:00:00 30/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [11:00:00 30/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [11:00:00 30/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [11:00:00 30/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [11:00:00 30/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [11:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [11:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [11:00:00 30/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [11:00:00 30/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 30/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [11:00:00 30/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [11:00:00 30/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [11:00:00 30/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [11:00:00 30/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [11:00:00 30/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [11:00:00 30/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [11:00:00 30/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 30/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 30/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [11:00:00 30/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [11:00:00 30/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [11:00:00 30/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 30/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [11:00:00 30/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 30/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [11:00:00 30/12/2015] id: Pacer Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [11:00:00 30/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [11:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 160 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [11:00:00 30/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [11:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [11:00:00 30/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [11:00:00 30/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: Total Lift st: NotStopd t0: [11:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 30/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [11:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [11:00:00 30/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 30/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 30/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [11:00:00 30/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [11:00:00 30/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [11:00:00 30/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [11:00:00 30/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Restraint DC'd st: NotStopd t0: [11:00:00 30/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [11:00:00 30/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: White v2: Thick st: NotStopd t0: [11:00:00 30/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Expectorated v2: Moderate st: NotStopd t0: [11:00:00 30/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 30/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [11:00:00 30/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:00:00 30/12/2015] id: Vent mA/Sensitivity el: 0 cu: CSRU cg: RN v1: 0 v2: 1.5 st: NotStopd t0: [11:00:00 30/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [11:00:00 30/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [11:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 30/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [11:00:00 30/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [11:00:00 30/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [11:00:00 30/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [11:00:00 30/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [11:00:00 30/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [11:00:00 30/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [11:00:00 30/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [11:00:00 30/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 100 vu: ml t0: [11:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [11:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [11:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [11:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 0 vu: ml
t0: [11:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:30:00 30/12/2015] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: Co-Wkr v1: 111 rs: Manual st: NotStopd
t0: [12:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [12:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 151 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [12:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [12:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [12:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 30/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [13:00:00 30/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [13:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 151 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [13:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [13:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 30/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [13:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [13:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [13:00:00 30/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [13:00:00 30/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [13:00:00 30/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [13:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [12:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [12:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [12:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 0 vu: ml t0: [13:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [13:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [13:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [13:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 0 vu: ml t0: [13:00:00 30/12/2015] id: Albumin 5% IV Infusions el: 1 cu: CSRU cg: RN ai: 222 vo: 250 vu: ml
t0: [12:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [13:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [12:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [13:00:00 30/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 30/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [13:00:00 30/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 30/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 30/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 30/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 30/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 30/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [13:00:00 30/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [13:00:00 30/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: Total Lift st: NotStopd t0: [13:00:00 30/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [13:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [13:00:00 30/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 30/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 30/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [14:00:00 30/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [14:00:00 30/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [14:00:00 30/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [14:00:00 30/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 30/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [14:00:00 30/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 30/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [14:00:00 30/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [14:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 30/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [14:00:00 30/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 30/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 30/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 30/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 30/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [14:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 30/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 30/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [14:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 30/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [14:00:00 30/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [14:00:00 30/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 30/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [14:00:00 30/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [14:00:00 30/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 30/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [14:00:00 30/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 30/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [14:00:00 30/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [14:00:00 30/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [14:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 30/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [14:00:00 30/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [14:00:00 30/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 30/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 30/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 30/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [14:00:00 30/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 30/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 30/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 30/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 30/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [14:00:00 30/12/2015] id: Pacer Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [14:00:00 30/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [14:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 134 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [14:00:00 30/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [14:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [14:00:00 30/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [14:00:00 30/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 30/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 30/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 30/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 30/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [14:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [14:00:00 30/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 30/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 30/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [14:00:00 30/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 30/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 30/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 30/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 30/12/2015] id: Vent mA/Sensitivity el: 0 cu: CSRU cg: RN v1: 0 v2: 1.5 st: NotStopd t0: [14:00:00 30/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 30/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [14:00:00 30/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [14:00:00 30/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [14:00:00 30/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 30/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [14:00:00 30/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [14:00:00 30/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [14:00:00 30/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [13:00:00 30/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [14:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [14:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [14:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [14:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [14:00:00 30/12/2015] tf: [01:31:00 05/01/2016] dt: 7891 id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [14:00:00 30/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 300 vu: ml t0: [14:00:00 30/12/2015] tf: [20:00:00 30/12/2015] dt: 360 id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 40 vu: ml t0: [14:00:00 30/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [14:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 30/12/2015] dt: 24 id: Drain #1 Total Out el: 3 cu: CSRU cg: RN cv: 300 ap: none
t0: [12:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [13:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [14:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [15:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 30/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [15:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [15:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [15:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 141 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [15:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [15:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [15:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [15:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [15:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [15:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [15:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [15:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [15:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 30/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [10:00:00 30/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Called st: NotStopd t0: [10:00:00 30/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Relative st: NotStopd t0: [11:00:00 30/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [14:00:00 30/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [15:00:00 30/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [15:00:00 30/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Relative st: NotStopd t0: [16:00:00 30/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 30/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [16:00:00 30/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 30/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 30/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [16:00:00 30/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 30/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [16:00:00 30/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 30/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [16:00:00 30/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 30/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 30/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 30/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 30/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 30/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 30/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 30/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 30/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 30/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 30/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 30/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 30/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 30/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [16:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 30/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [16:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [16:00:00 30/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 30/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 30/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 30/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 30/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 30/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 30/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 30/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 30/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 30/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 30/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [16:00:00 30/12/2015] id: Pacer Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [16:00:00 30/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [16:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 129 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [16:00:00 30/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [16:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [16:00:00 30/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 30/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 30/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [16:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [16:00:00 30/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 30/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 30/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [16:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 30/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 30/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [16:00:00 30/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [16:00:00 30/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 30/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 30/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 30/12/2015] id: Vent mA/Sensitivity el: 0 cu: CSRU cg: RN v1: 0 v2: 1.5 st: NotStopd t0: [16:00:00 30/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 30/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [16:00:00 30/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 30/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [16:00:00 30/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 30/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [16:00:00 30/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 30/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 30/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [17:00:00 30/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Family at Bedsid st: NotStopd t0: [17:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 30/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [17:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 30/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [17:00:00 30/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 30/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [17:00:00 30/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [17:00:00 30/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [17:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 78 u1: BPM st: NotStopd t0: [17:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [17:00:00 30/12/2015] id: Imp Skin Cleanse #1 el: 0 cu: CSRU cg: RN v1: Soap & H20 st: NotStopd t0: [17:00:00 30/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [17:00:00 30/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [17:00:00 30/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [17:00:00 30/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [17:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 145 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [17:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [17:00:00 30/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [17:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [17:00:00 30/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [17:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [17:00:00 30/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [17:00:00 30/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [17:00:00 30/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Restraint DC'd st: NotStopd t0: [17:00:00 30/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [17:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [17:00:00 30/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [17:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [16:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [16:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [16:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [16:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [17:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [17:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [17:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [17:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [17:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [16:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [17:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:00:00 30/12/2015] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd
t0: [18:00:00 30/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [18:00:00 30/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [18:00:00 30/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [18:00:00 30/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [18:00:00 30/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [18:00:00 30/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [18:00:00 30/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [18:00:00 30/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [18:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 30/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [18:00:00 30/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [18:00:00 30/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [18:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 30/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [18:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 30/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [18:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 30/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [18:00:00 30/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [18:00:00 30/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [18:00:00 30/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [18:00:00 30/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [18:00:00 30/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [18:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [18:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 30/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [18:00:00 30/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 30/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 30/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [18:00:00 30/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [18:00:00 30/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [18:00:00 30/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [18:00:00 30/12/2015] id: Pacer Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [18:00:00 30/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [18:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 122 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [18:00:00 30/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [18:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [18:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [18:00:00 30/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 30/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 30/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [18:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 6 u1: BPM st: NotStopd t0: [18:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 30/12/2015] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden v2: Formed st: NotStopd t0: [18:00:00 30/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [18:00:00 30/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [18:00:00 30/12/2015] id: Vent mA/Sensitivity el: 0 cu: CSRU cg: RN v1: 0 v2: 1.5 st: NotStopd t0: [18:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 30/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [18:00:00 30/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [18:00:00 30/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [18:00:00 30/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [18:00:00 30/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [18:00:00 30/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [18:00:00 30/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [18:00:00 30/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [18:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [18:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [18:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [18:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [18:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [18:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:16:00 30/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [17:16:00 30/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.7 rs: Final st: NotStopd t0: [17:16:00 30/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [17:16:00 30/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.7 rs: Final st: NotStopd
t0: [18:00:00 30/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 12.5714 u1: ml/cmH st: NotStopd t0: [18:00:00 30/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [18:00:00 30/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [18:00:00 30/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [18:00:00 30/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [18:00:00 30/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [18:00:00 30/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.0 st: NotStopd t0: [18:00:00 30/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [18:00:00 30/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [18:00:00 30/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 2 u1: Deg. C st: NotStopd t0: [18:00:00 30/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [18:00:00 30/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [18:00:00 30/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [18:00:00 30/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [18:00:00 30/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [18:00:00 30/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 13.1 u1: L/min st: NotStopd t0: [18:00:00 30/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [18:00:00 30/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [18:00:00 30/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [18:00:00 30/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [18:00:00 30/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [18:00:00 30/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [18:00:00 30/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [18:00:00 30/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [18:00:00 30/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 460 u1: ml/B st: NotStopd t0: [18:00:00 30/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [18:00:00 30/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [18:00:00 30/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [18:00:00 30/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [14:00:00 30/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [14:00:00 30/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [14:00:00 30/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [14:00:00 30/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [14:00:00 30/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [14:00:00 30/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [14:00:00 30/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [14:00:00 30/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [14:00:00 30/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [14:00:00 30/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [14:00:00 30/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [14:00:00 30/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [14:00:00 30/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [14:00:00 30/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [14:00:00 30/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [14:00:00 30/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [14:00:00 30/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White v2: Thick st: NotStopd t0: [14:00:00 30/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [14:00:00 30/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [14:00:00 30/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [14:00:00 30/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [14:00:00 30/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [14:00:00 30/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 30/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 11.5789 u1: ml/cmH st: NotStopd t0: [20:00:00 30/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [20:00:00 30/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 30/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 30/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 30/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 30/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 30/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 30/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 2 u1: Deg. C st: NotStopd t0: [20:00:00 30/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 30/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 30/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 30/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 30/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [20:00:00 30/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [20:00:00 30/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 30/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 30/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 43 u1: cmH2O st: NotStopd t0: [20:00:00 30/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [20:00:00 30/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [20:00:00 30/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 30/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [20:00:00 30/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:00:00 30/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White v2: Thick st: NotStopd t0: [20:00:00 30/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [20:00:00 30/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 475 u1: ml/B st: NotStopd t0: [20:00:00 30/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 30/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 465 u1: ml/B st: NotStopd t0: [20:00:00 30/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [20:00:00 30/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 30/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [19:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 30/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [19:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [19:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 123 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [19:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [19:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [19:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 13 u1: BPM st: NotStopd t0: [19:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [19:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 30/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 30/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [20:00:00 30/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [20:00:00 30/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 30/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 30/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [20:00:00 30/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 30/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 30/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 30/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [20:00:00 30/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [20:00:00 30/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 30/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 30/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 30/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 30/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 30/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 30/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 30/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 30/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 30/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 30/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 30/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 30/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 30/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 30/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 30/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 30/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 30/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 30/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 30/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 30/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 30/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 30/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [20:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 30/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 30/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 30/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 30/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [20:00:00 30/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 30/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 30/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 30/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 30/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 30/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 30/12/2015] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 30/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [20:00:00 30/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 30/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 30/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 30/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 30/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: Serosanguinous v2: Small st: NotStopd t0: [20:00:00 30/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 30/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 30/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 30/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 30/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 30/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 30/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 30/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 30/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 30/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 30/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 30/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [20:00:00 30/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [20:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 136 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [20:00:00 30/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [20:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [20:00:00 30/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 30/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [20:00:00 30/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 30/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 30/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 30/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 30/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [20:00:00 30/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 30/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 30/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 30/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 30/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 30/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 30/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 30/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [20:00:00 30/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [20:00:00 30/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 30/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 30/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 30/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 30/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 30/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 30/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 30/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 30/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 30/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [20:00:00 30/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 30/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 30/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 30/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 30/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [20:00:00 30/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [20:00:00 30/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 30/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [19:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [19:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [19:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [19:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [19:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [20:00:00 30/12/2015] tf: [09:00:00 31/12/2015] dt: 780 id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 35 vu: ml t0: [20:00:00 30/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [20:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [20:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [20:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [20:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [20:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [20:00:00 30/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [20:00:00 30/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [19:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [21:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 30/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [21:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 30/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 30/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 78 u1: BPM st: NotStopd t0: [21:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [21:00:00 30/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 30/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 30/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 138 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [21:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [21:00:00 30/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 30/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 30/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [21:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [21:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [21:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 30/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [21:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [21:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [21:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [21:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [21:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 30/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [22:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [22:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 149 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [22:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [22:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [22:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [22:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 30/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [22:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [22:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [22:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [22:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [22:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [22:00:00 30/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [22:00:00 30/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [22:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 30/12/2015] dt: 24 id: Stool Out Total el: 3 cu: CSRU cg: RN cv: 0 ap: carryForward
t0: [23:00:00 30/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 30/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [23:00:00 30/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 30/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [23:00:00 30/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 30/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 30/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 30/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [23:00:00 30/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [23:00:00 30/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 30/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 30/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [23:00:00 30/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [23:00:00 30/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 143 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [23:00:00 30/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [23:00:00 30/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [23:00:00 30/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [23:00:00 30/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 30/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [23:00:00 30/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [23:00:00 30/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [23:00:00 30/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 30/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [23:00:00 30/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 30/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [23:00:00 30/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [23:00:00 30/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [23:00:00 30/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [23:00:00 30/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [23:00:00 30/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 30/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:00:00 30/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 30/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [22:00:00 30/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [22:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [22:00:00 30/12/2015] id: Pain Location el: 0 cu: CSRU cg: RN v1: Not Indicated st: NotStopd t0: [22:00:00 30/12/2015] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [23:00:00 30/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [00:00:00 31/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 31/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [00:00:00 31/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [00:00:00 31/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 31/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 31/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 31/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 31/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [00:00:00 31/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 31/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [00:00:00 31/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [00:00:00 31/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [00:00:00 31/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 31/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 31/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 31/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 31/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 31/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 31/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 31/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 31/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 31/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 31/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 31/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [00:00:00 31/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 31/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 31/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 31/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 31/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 31/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 31/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 31/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 31/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [00:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 31/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 31/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 31/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 31/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [00:00:00 31/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 31/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 31/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 31/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [00:00:00 31/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 31/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 31/12/2015] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 31/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [00:00:00 31/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 31/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 31/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 31/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 31/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: Serosanguinous v2: Small st: NotStopd t0: [00:00:00 31/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 31/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 31/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 31/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 31/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 31/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 31/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 31/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 31/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 31/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 31/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 31/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [00:00:00 31/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [00:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 139 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [00:00:00 31/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [00:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [00:00:00 31/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 31/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [00:00:00 31/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 31/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 31/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 31/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 31/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [00:00:00 31/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 31/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 31/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 31/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 31/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 31/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 31/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 31/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [00:00:00 31/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [00:00:00 31/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 31/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 31/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 31/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [00:00:00 31/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 31/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [00:00:00 31/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 31/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [00:00:00 31/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [00:00:00 31/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 31/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [00:00:00 31/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 10 vu: ml t0: [00:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [00:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [00:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [00:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [00:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [00:00:00 31/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [00:00:00 31/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [00:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [00:04:00 31/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [00:04:00 31/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 97 rs: Final st: NotStopd t0: [00:04:00 31/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.3 rs: Final st: NotStopd t0: [00:04:00 31/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: no data rs: Final st: NotStopd t0: [00:04:00 31/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: no data rs: Final st: NotStopd t0: [00:04:00 31/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 u1: mmHg rs: Final st: NotStopd t0: [00:04:00 31/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 u1: mmHg rs: Final st: NotStopd t0: [00:04:00 31/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [00:04:00 31/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 97 rs: Final st: NotStopd t0: [00:04:00 31/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.11 rs: Final st: NotStopd t0: [00:04:00 31/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.3 rs: Final st: NotStopd
t0: [00:50:00 31/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 12.9412 u1: ml/cmH st: NotStopd t0: [00:50:00 31/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [00:50:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:50:00 31/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:50:00 31/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:50:00 31/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.0 st: NotStopd t0: [00:50:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:50:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:50:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:50:00 31/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [00:50:00 31/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:50:00 31/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:50:00 31/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [00:50:00 31/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.1 u1: L/min st: NotStopd t0: [00:50:00 31/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:50:00 31/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:50:00 31/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 39 u1: cmH2O st: NotStopd t0: [00:50:00 31/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [00:50:00 31/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [00:50:00 31/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [00:50:00 31/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [00:50:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:50:00 31/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White v2: Thick st: NotStopd t0: [00:50:00 31/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [00:50:00 31/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 419 u1: ml/B st: NotStopd t0: [00:50:00 31/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [00:50:00 31/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [00:50:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [00:50:00 31/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [01:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [01:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [01:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [01:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [01:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [01:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [01:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [01:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [01:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [01:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [01:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [01:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [01:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [02:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [02:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [02:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [02:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [02:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [02:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [02:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [02:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [02:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [02:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [02:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [02:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [03:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [03:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 82 u1: BPM st: NotStopd t0: [03:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [03:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 156 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [03:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 109 u1: mmHg st: NotStopd t0: [03:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [03:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [03:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [03:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [03:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [03:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [03:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [03:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [03:00:00 31/12/2015] id: IV #2 Reason DC'D el: 0 cu: CSRU cg: -1 st: D/C'd t0: [03:00:00 31/12/2015] id: IV #2 D/C Date el: 0 cu: CSRU cg: -1 st: D/C'd t0: [03:00:00 31/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: -1 st: D/C'd t0: [03:00:00 31/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: -1 st: D/C'd t0: [03:00:00 31/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [03:33:00 31/12/2015] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.39 rs: Final st: NotStopd t0: [03:33:00 31/12/2015] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [03:33:00 31/12/2015] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [03:33:00 31/12/2015] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 42 u1: mmHg rs: Final st: NotStopd t0: [03:33:00 31/12/2015] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 132 u1: mmHg rs: Final st: NotStopd t0: [03:33:00 31/12/2015] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.39 rs: Final st: NotStopd
t0: [17:00:00 30/12/2015] id: IV #2 Reason DC'D el: 0 cu: CSRU cg: RN v1: Infiltrated st: NotStopd t0: [17:00:00 30/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 28 st: NotStopd t0: [17:00:00 30/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN v1: RL Post Forearm v2: 20 gauge st: NotStopd t0: [20:00:00 30/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN st: NotStopd t0: [20:00:00 30/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN st: NotStopd t0: [20:00:00 30/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN st: NotStopd t0: [00:00:00 31/12/2015] id: IV #2 Insert Date el: 0 cu: CSRU cg: RN st: NotStopd t0: [00:00:00 31/12/2015] id: IV #2 Site/Size el: 0 cu: CSRU cg: RN st: NotStopd t0: [00:00:00 31/12/2015] id: IV Site Appear #2 el: 0 cu: CSRU cg: RN st: NotStopd t0: [02:00:00 31/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [02:00:00 31/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [02:00:00 31/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [02:00:00 31/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [02:00:00 31/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [02:00:00 31/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [02:00:00 31/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [02:00:00 31/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [03:00:00 31/12/2015] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:00:00 31/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [03:00:00 31/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 31/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [03:00:00 31/12/2015] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:00:00 31/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 31/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [03:00:00 31/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 31/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [03:00:00 31/12/2015] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:00:00 31/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [03:00:00 31/12/2015] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:33:00 31/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 132 rs: Final st: NotStopd t0: [03:33:00 31/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.7 rs: Final st: NotStopd t0: [03:33:00 31/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 132 rs: Final st: NotStopd t0: [03:33:00 31/12/2015] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.18 rs: Final st: NotStopd t0: [03:33:00 31/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.7 rs: Final st: NotStopd t0: [04:00:00 31/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 31/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [04:00:00 31/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [04:00:00 31/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 31/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 31/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 31/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [04:00:00 31/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 31/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [04:00:00 31/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [04:00:00 31/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 31/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 31/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 31/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 31/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 31/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 31/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 31/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 31/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [04:00:00 31/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 31/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 31/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 31/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 31/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 31/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 31/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 31/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 31/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 31/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 31/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 31/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 31/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [04:00:00 31/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 31/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 31/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 31/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [04:00:00 31/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 31/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [04:00:00 31/12/2015] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 31/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 31/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 31/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 31/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [04:00:00 31/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 31/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: Serosanguinous v2: Small st: NotStopd t0: [04:00:00 31/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 31/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 31/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 31/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 31/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 31/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 31/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [04:00:00 31/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 31/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 31/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 31/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 31/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [04:00:00 31/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [04:00:00 31/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [04:00:00 31/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 31/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 31/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [04:00:00 31/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 31/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 31/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 31/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 31/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 31/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 31/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 31/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 31/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 31/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 31/12/2015] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden v2: Loose st: NotStopd t0: [04:00:00 31/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 31/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 31/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 31/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 31/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [04:00:00 31/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [04:00:00 31/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 31/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 31/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 31/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [04:00:00 31/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 16 u1: number st: NotStopd t0: [04:00:00 31/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 31/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 31/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [04:00:00 31/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 31/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [04:00:00 31/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [04:00:00 31/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 31/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [23:00:00 30/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: White v2: Thick st: NotStopd t0: [23:00:00 30/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [03:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 31/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 31/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 31/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd
t0: [04:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [04:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 31/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 31/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 81 u1: BPM st: NotStopd t0: [04:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [04:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 159 u1: mmHg v2: 89 u2: mmHg st: NotStopd t0: [04:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [04:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [04:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [04:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 31/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 31/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [04:00:00 31/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.2 u1: Deg. F st: NotStopd t0: [04:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 31/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 10 vu: ml t0: [04:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [04:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [04:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [04:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [04:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [04:00:00 31/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [04:00:00 31/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [04:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 31/12/2015] dt: 24 id: Stool Out Total el: 3 cu: CSRU cg: RN cv: 0 ap: carryForward t0: [23:00:00 31/12/2015] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN pv: 0 cv: 30 ap: none
t0: [03:36:00 31/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 18.4 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 18.4 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 36.8 u1: % rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 11.9 u1: gm/dl rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 442 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 4.15 u1: /mic l rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 18.4 rs: Final st: NotStopd
t0: [00:50:00 31/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [00:50:00 31/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [00:50:00 31/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:30:00 31/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.1935 u1: ml/cmH st: NotStopd t0: [04:30:00 31/12/2015] id: RSBI Not Completed el: 0 cu: CSRU cg: RRT v1: Other/Remarks st: NotStopd t0: [04:30:00 31/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [04:30:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:30:00 31/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:30:00 31/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [04:30:00 31/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [04:30:00 31/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.0 st: NotStopd t0: [04:30:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:30:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:30:00 31/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [04:30:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:30:00 31/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [04:30:00 31/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:30:00 31/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:30:00 31/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [04:30:00 31/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [04:30:00 31/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:30:00 31/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:30:00 31/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [04:30:00 31/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [04:30:00 31/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [04:30:00 31/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [04:30:00 31/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [04:30:00 31/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:30:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [04:30:00 31/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 445 u1: ml/B st: NotStopd t0: [04:30:00 31/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [04:30:00 31/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 63 u1: ml/B st: NotStopd t0: [04:30:00 31/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [04:30:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [04:30:00 31/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [03:36:00 31/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 45 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 102 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 4 u1: mEq/L rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 45 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 102 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4 u1: mEq/L rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd
t0: [03:36:00 31/12/2015] id: PT el: 0 cu: CSRU cg: 3161 v1: 13.7 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 48.9 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 13.7 rs: Final st: NotStopd t0: [03:36:00 31/12/2015] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 48.9 rs: Final st: NotStopd
t0: [05:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [05:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [05:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [05:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 130 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [05:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [05:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [05:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [05:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [05:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [05:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [05:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [05:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [05:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [05:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [06:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [06:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Agitated st: NotStopd t0: [06:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [06:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [06:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 134 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [06:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [06:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 31/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 67.9 u1: kg st: NotStopd t0: [06:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 31/12/2015] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.12965 u1: m2 st: NotStopd t0: [06:00:00 31/12/2015] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.32094 u1: m2 st: NotStopd t0: [06:00:00 31/12/2015] id: Weight Change el: 0 cu: CSRU cg: RN v1: 0.7 u1: kg st: NotStopd t0: [06:00:00 31/12/2015] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd
t0: [06:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [06:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [06:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [06:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [06:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [06:00:00 31/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 300 vu: ml
t0: [06:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 31/12/2015] dt: 24 id: Drain #1 Total Out el: 3 cu: CSRU cg: RN cv: 350 ap: none
t0: [06:00:00 31/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [06:00:00 31/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 31/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [06:00:00 31/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [06:00:00 31/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [06:00:00 31/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [06:00:00 31/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd
t0: [08:38:00 31/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [08:38:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:38:00 31/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:38:00 31/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:38:00 31/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [08:38:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:38:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:38:00 31/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [08:38:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:38:00 31/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [08:38:00 31/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:38:00 31/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:38:00 31/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [08:38:00 31/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [08:38:00 31/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:38:00 31/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:38:00 31/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [08:38:00 31/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:38:00 31/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [08:38:00 31/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [08:38:00 31/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [08:38:00 31/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:38:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:38:00 31/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White v2: Thin st: NotStopd t0: [08:38:00 31/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [08:38:00 31/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 439 u1: ml/B st: NotStopd t0: [08:38:00 31/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:38:00 31/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 60 u1: ml/B st: NotStopd t0: [08:38:00 31/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [08:38:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [08:38:00 31/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [07:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [07:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 79 u1: BPM st: NotStopd t0: [07:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [07:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 163 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [07:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [07:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [07:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [07:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [07:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 31/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 31/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 31/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 31/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 31/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 31/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 31/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [08:00:00 31/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 31/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 31/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [08:00:00 31/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 31/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 31/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 31/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 31/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 31/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 31/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 31/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 31/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 31/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 31/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 31/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 31/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 31/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 31/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 31/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 31/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 31/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 31/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 31/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [08:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 31/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 31/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 24 st: NotStopd t0: [08:00:00 31/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 31/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 31/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 31/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 31/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [08:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [08:00:00 31/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 31/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 31/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [08:00:00 31/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 31/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 31/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 31/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 31/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 31/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 31/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 31/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 31/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 31/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 31/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 31/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 31/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [08:00:00 31/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [08:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 144 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [08:00:00 31/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [08:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [08:00:00 31/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 31/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [08:00:00 31/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 31/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 31/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 31/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 31/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [08:00:00 31/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 31/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 31/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 31/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 31/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [08:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 31/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 31/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 31/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [08:00:00 31/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [08:00:00 31/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 31/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 31/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 31/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 31/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 31/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 31/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 31/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 31/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 31/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 31/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [09:00:00 31/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [09:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [09:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [09:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 31/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [09:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [09:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [09:00:00 31/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 31/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [09:00:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [09:00:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [09:00:00 31/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 137 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [09:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [09:00:00 31/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [09:00:00 31/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 31/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [09:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [09:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 43 u1: BPM st: NotStopd t0: [09:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [09:00:00 31/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Clear v2: Thick st: NotStopd t0: [09:00:00 31/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Expectorated v2: Copious st: NotStopd t0: [09:00:00 31/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [09:00:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [09:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [10:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 77 u1: BPM st: NotStopd t0: [10:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.6 t0: [10:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 147 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [10:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [10:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [10:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 10 u1: BPM st: NotStopd t0: [10:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [07:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [07:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [07:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [07:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [08:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [08:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [08:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [08:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [08:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [09:00:00 31/12/2015] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [09:00:00 31/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [09:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [09:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [09:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [09:00:00 31/12/2015] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml t0: [09:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [09:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [10:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [10:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [10:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 25 vu: ml t0: [10:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 12.5 vu: ml t0: [10:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [07:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [08:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip
t0: [10:30:00 31/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [10:30:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [10:30:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 5 vu: ml t0: [10:30:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 25 vu: ml t0: [10:30:00 31/12/2015] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 30 vu: ml t0: [10:30:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 6.25 vu: ml t0: [10:30:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 20 vu: ml
t0: [23:00:00 31/12/2015] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 120 ap: none
t0: [11:00:00 31/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [11:00:00 31/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [11:00:00 31/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [11:00:00 31/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [11:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 31/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [11:00:00 31/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [11:00:00 31/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [11:00:00 31/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [11:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 31/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [11:00:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [11:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 31/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [11:00:00 31/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [11:00:00 31/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [11:00:00 31/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [11:00:00 31/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [11:00:00 31/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [11:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [11:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 31/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [11:00:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [11:00:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [11:00:00 31/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [11:00:00 31/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [11:00:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [11:00:00 31/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 31/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 31/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 31/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [11:00:00 31/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [11:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 144 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [11:00:00 31/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [11:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [11:00:00 31/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [11:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [11:00:00 31/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 31/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 31/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [11:00:00 31/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [11:00:00 31/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [11:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [11:00:00 31/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [11:00:00 31/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [11:00:00 31/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [11:00:00 31/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 31/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Brown v2: Thick st: NotStopd t0: [11:00:00 31/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [11:00:00 31/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 31/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:00:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [11:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 31/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [11:30:00 31/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [11:30:00 31/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: Total Lift st: NotStopd t0: [11:30:00 31/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [12:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 31/12/2015] id: CVP el: 0 cu: CSRU cg: RN v1: 0 u1: mmHg st: NotStopd t0: [12:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 78 u1: BPM st: NotStopd t0: [12:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 148 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [12:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [12:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [12:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [12:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [12:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 15 vu: ml t0: [12:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 25 vu: ml t0: [12:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: RN ai: 304 vo: 18.75 vu: ml t0: [12:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 60 vu: ml
t0: [11:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip
t0: [12:00:00 31/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 31/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 31/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 31/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [12:00:00 31/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd
t0: [11:56:00 31/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [11:56:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [11:56:00 31/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:56:00 31/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [11:56:00 31/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [11:56:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [11:56:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [11:56:00 31/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [11:56:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:56:00 31/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [11:56:00 31/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:56:00 31/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:56:00 31/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [11:56:00 31/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 13.4 u1: L/min st: NotStopd t0: [11:56:00 31/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:56:00 31/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [11:56:00 31/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [11:56:00 31/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [11:56:00 31/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [11:56:00 31/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [11:56:00 31/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [11:56:00 31/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [11:56:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [11:56:00 31/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 452 u1: ml/B st: NotStopd t0: [11:56:00 31/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [11:56:00 31/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 61 u1: ml/B st: NotStopd t0: [11:56:00 31/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [11:56:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [11:56:00 31/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [11:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.6 t0: [12:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.6 t0: [12:00:00 31/12/2015] id: Procedures el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 31/12/2015] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 126 rs: Manual st: NotStopd
t0: [13:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: -1 ai: 168 vo: 0 st: D/C'd t0: [13:00:00 31/12/2015] id: D5W 250.0ml + 600mgmin Amiodarone IV Infusions el: 1 cu: CSRU cg: -1 ai: 304 vo: 0 st: D/C'd
t0: [13:00:00 31/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [13:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 83 u1: BPM st: NotStopd t0: [13:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.6 t0: [13:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 190 u1: mmHg v2: 93 u2: mmHg st: NotStopd t0: [13:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 128 u1: mmHg st: NotStopd t0: [13:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [13:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [13:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [13:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 25 vu: ml t0: [13:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [08:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [09:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [10:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [11:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [12:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 du: mgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [13:00:00 31/12/2015] id: Amiodarone el: 1 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 31/12/2015] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 220 cv: 220 ap: none t0: [23:00:00 31/12/2015] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -132 cv: -132 ap: none t0: [23:00:00 31/12/2015] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 10 cv: 1162.5 ap: none t0: [23:00:00 31/12/2015] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 88 cv: 2950.5 ap: none t0: [23:00:00 31/12/2015] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 960 ap: none t0: [23:00:00 31/12/2015] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 220 cv: 5060 ap: none t0: [23:00:00 31/12/2015] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -132 cv: -2489.5 ap: carryForward t0: [23:00:00 31/12/2015] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 220 cv: 5440 ap: carryForward t0: [23:00:00 31/12/2015] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -132 cv: 5587.34 ap: carryForward
t0: [13:38:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [13:38:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:38:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [13:38:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [13:38:00 31/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [13:38:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [13:38:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [11:00:00 31/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [11:00:00 31/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 31/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 31/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: Total Lift st: NotStopd t0: [11:00:00 31/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [13:00:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [13:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [13:00:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [13:00:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [13:00:00 31/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Brown v2: Thick st: NotStopd t0: [13:00:00 31/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [13:00:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [14:00:00 31/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 31/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [14:00:00 31/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [14:00:00 31/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [14:00:00 31/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [14:00:00 31/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [14:00:00 31/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 31/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [14:00:00 31/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [14:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 31/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 31/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 31/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 31/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 31/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 31/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [14:00:00 31/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [14:00:00 31/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [14:00:00 31/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 31/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [14:00:00 31/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [14:00:00 31/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [14:00:00 31/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [14:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 31/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [14:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [14:00:00 31/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [14:00:00 31/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [14:00:00 31/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 31/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 31/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 31/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 31/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 31/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [14:00:00 31/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Protect & Secure st: NotStopd t0: [14:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 141 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [14:00:00 31/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [14:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [14:00:00 31/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [14:00:00 31/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 31/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 31/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 31/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [14:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [14:00:00 31/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 31/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 31/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 31/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 31/12/2015] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden v2: Formed st: NotStopd t0: [14:00:00 31/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 31/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 31/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 31/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [14:00:00 31/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [14:00:00 31/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [14:00:00 31/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 31/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [14:00:00 31/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [14:00:00 31/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [14:00:00 31/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [15:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [15:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 31/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [15:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 79 u1: BPM st: NotStopd t0: [15:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [15:00:00 31/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 31/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [15:00:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [15:00:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [15:00:00 31/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 156 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [15:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [15:00:00 31/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [15:00:00 31/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 31/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [15:00:00 31/12/2015] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [15:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [15:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [15:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 31/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Brown v2: Thick st: NotStopd t0: [15:00:00 31/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [15:00:00 31/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [15:00:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [15:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [14:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [14:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [15:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [15:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [15:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [16:00:00 31/12/2015] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: INV Line#1 D/C Date el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: INV Line#1InsertDate el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: CT #1 Crepitus el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: CT #1 Drainage el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: CT #2 Crepitus el: 0 cu: CSRU cg: -1 st: D/C'd t0: [16:00:00 31/12/2015] id: CT #2 Drainage el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [16:03:00 31/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.6667 u1: ml/cmH st: NotStopd t0: [16:03:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:03:00 31/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:03:00 31/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [16:03:00 31/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [16:03:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:03:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [16:03:00 31/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [16:03:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:03:00 31/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [16:03:00 31/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:03:00 31/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:03:00 31/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [16:03:00 31/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 14 u1: L/min st: NotStopd t0: [16:03:00 31/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:03:00 31/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [16:03:00 31/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [16:03:00 31/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [16:03:00 31/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [16:03:00 31/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [16:03:00 31/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [16:03:00 31/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:03:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [16:03:00 31/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 445 u1: ml/B st: NotStopd t0: [16:03:00 31/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [16:03:00 31/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 53 u1: ml/B st: NotStopd t0: [16:03:00 31/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [16:03:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [16:03:00 31/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [16:00:00 31/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Changed st: NotStopd t0: [16:00:00 31/12/2015] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 31/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 31/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 31/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 31/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [16:00:00 31/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 31/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [16:00:00 31/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 31/12/2015] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 31/12/2015] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 31/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 31/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 31/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 31/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 31/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 31/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 31/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 31/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 31/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 79 u1: BPM st: NotStopd t0: [16:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 31/12/2015] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [16:00:00 31/12/2015] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [16:00:00 31/12/2015] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 31/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 31/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [16:00:00 31/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 31/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [16:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0 t0: [16:00:00 31/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 31/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 31/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 31/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 31/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: RN v1: Epicardial Wires st: NotStopd t0: [16:00:00 31/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: RN v1: Wires DC'd st: NotStopd t0: [16:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 161 u1: mmHg v2: 91 u2: mmHg st: NotStopd t0: [16:00:00 31/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: RN v1: 2 st: NotStopd t0: [16:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [16:00:00 31/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [16:00:00 31/12/2015] id: Procedures el: 0 cu: CSRU cg: RN v1: Chest Tube D/C st: NotStopd t0: [16:00:00 31/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 31/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 31/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [16:00:00 31/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 31/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 31/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [16:00:00 31/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [16:00:00 31/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 31/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 31/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [16:00:00 31/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Changed st: NotStopd t0: [16:00:00 31/12/2015] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:30:00 31/12/2015] id: Procedures el: 0 cu: CSRU cg: RN v1: Blood Cultured st: NotStopd t0: [17:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [17:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0 t0: [17:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [17:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [17:00:00 31/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [17:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 31/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [17:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [17:00:00 31/12/2015] id: Radiologic Study el: 0 cu: CSRU cg: RN v1: Chest Xray st: NotStopd t0: [17:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 8 u1: BPM st: NotStopd t0: [17:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [16:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [17:00:00 31/12/2015] id: Chest Tubes Right Pleural 1 el: 1 cu: CSRU cg: -1 vo: 0 st: D/C'd t0: [17:00:00 31/12/2015] id: Chest Tubes Mediastinal el: 1 cu: CSRU cg: -1 vo: 0 st: D/C'd
t0: [16:00:00 31/12/2015] id: Drain Out #1 Other el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [16:00:00 31/12/2015] id: BUN el: 0 cu: CSRU cg: 3161 v1: 44 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Albumin Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.5 u1: mg/dl rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 102 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 75 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.9 u1: mEq/L rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Total Bili Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: ALT Enzymes el: 0 cu: CSRU cg: 3161 v1: 6 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: AST Enzymes el: 0 cu: CSRU cg: 3161 v1: 19 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Albumin (>3.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Alk. Phosphate Enzymes el: 0 cu: CSRU cg: 3161 v1: 179 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Amylase Enzymes el: 0 cu: CSRU cg: 3161 v1: 38 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 44 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.5 u1: mg/dl rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 27 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 102 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 75 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: LDH Enzymes el: 0 cu: CSRU cg: 3161 v1: 167 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.9 u1: mEq/L rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd t0: [16:00:00 31/12/2015] id: Total Bili (0-1.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd
t0: [17:00:00 31/12/2015] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 81 rs: Manual st: NotStopd
t0: [16:00:00 31/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 31/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [16:00:00 31/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 31/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 31/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 31/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 31/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 31/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 31/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 31/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 31/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Family at Bedsid st: NotStopd t0: [18:00:00 31/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 31/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [18:00:00 31/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [18:00:00 31/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [18:00:00 31/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [18:00:00 31/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [18:00:00 31/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [18:00:00 31/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 31/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 31/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 31/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [18:00:00 31/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 31/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd
t0: [18:00:00 31/12/2015] tf: [21:00:00 31/12/2015] dt: 180 id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [17:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [17:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [17:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [18:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [18:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [18:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [20:00:00 31/12/2015] id: Pacemaker Mode el: 0 cu: CSRU cg: -1 st: D/C'd t0: [20:00:00 31/12/2015] id: Pacemaker Type el: 0 cu: CSRU cg: -1 st: D/C'd t0: [20:00:00 31/12/2015] id: Pacer Rate el: 0 cu: CSRU cg: -1 st: D/C'd t0: [20:00:00 31/12/2015] id: Pacer Wire Condition el: 0 cu: CSRU cg: -1 st: D/C'd t0: [20:00:00 31/12/2015] id: Pacer Wires Vent el: 0 cu: CSRU cg: -1 st: D/C'd t0: [20:00:00 31/12/2015] id: Vent Sens/Capture el: 0 cu: CSRU cg: -1 st: D/C'd t0: [20:00:00 31/12/2015] id: Vent Threshold el: 0 cu: CSRU cg: -1 st: D/C'd t0: [20:00:00 31/12/2015] id: Vent mA/Sensitivity el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [19:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 31/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [19:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 84 u1: BPM st: NotStopd t0: [19:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [19:00:00 31/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [19:00:00 31/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [19:00:00 31/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [19:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 166 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [19:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [19:00:00 31/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [19:00:00 31/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [19:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 31/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [19:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [19:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [19:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 31/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [19:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 31/12/2015] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 31/12/2015] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 31/12/2015] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 31/12/2015] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [20:00:00 31/12/2015] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 31/12/2015] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [20:00:00 31/12/2015] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 31/12/2015] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [20:00:00 31/12/2015] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [20:00:00 31/12/2015] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 31/12/2015] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 31/12/2015] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 31/12/2015] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 31/12/2015] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 31/12/2015] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 31/12/2015] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 31/12/2015] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 31/12/2015] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 31/12/2015] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 31/12/2015] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 31/12/2015] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 31/12/2015] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 31/12/2015] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 31/12/2015] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 31/12/2015] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 31/12/2015] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 31/12/2015] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 31/12/2015] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 31/12/2015] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 31/12/2015] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 77 u1: BPM st: NotStopd t0: [20:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 31/12/2015] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 31/12/2015] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 31/12/2015] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 31/12/2015] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 31/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 31/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 31/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 31/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 31/12/2015] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 31/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [20:00:00 31/12/2015] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 31/12/2015] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 31/12/2015] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [20:00:00 31/12/2015] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 31/12/2015] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 31/12/2015] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 31/12/2015] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 31/12/2015] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 31/12/2015] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 31/12/2015] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 31/12/2015] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 31/12/2015] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [20:00:00 31/12/2015] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 31/12/2015] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 31/12/2015] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 149 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [20:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [20:00:00 31/12/2015] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 31/12/2015] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [20:00:00 31/12/2015] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 31/12/2015] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 6 mm v2: 6 mm st: NotStopd t0: [20:00:00 31/12/2015] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 31/12/2015] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 31/12/2015] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 31/12/2015] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 31/12/2015] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 4 u1: BPM st: NotStopd t0: [20:00:00 31/12/2015] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 31/12/2015] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 31/12/2015] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 31/12/2015] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 31/12/2015] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 31/12/2015] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden v2: Formed st: NotStopd t0: [20:00:00 31/12/2015] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 31/12/2015] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 31/12/2015] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2778 u1: Deg. C st: NotStopd t0: [20:00:00 31/12/2015] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.3 u1: Deg. F st: NotStopd t0: [20:00:00 31/12/2015] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 31/12/2015] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 31/12/2015] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 31/12/2015] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [20:00:00 31/12/2015] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [20:00:00 31/12/2015] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 31/12/2015] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 31/12/2015] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 31/12/2015] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 31/12/2015] id: Braden Score el: 0 cu: CSRU cg: RN v1: 16 u1: number st: NotStopd t0: [20:00:00 31/12/2015] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 31/12/2015] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [19:00:00 31/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [20:00:00 31/12/2015] tf: [07:00:00 02/01/2016] dt: 2100 id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 10 vu: ml t0: [20:00:00 31/12/2015] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vu: ml t0: [20:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [20:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [20:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml
t0: [21:00:00 31/12/2015] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.3333 u1: ml/cmH st: NotStopd t0: [21:00:00 31/12/2015] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [21:00:00 31/12/2015] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [21:00:00 31/12/2015] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [21:00:00 31/12/2015] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [21:00:00 31/12/2015] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [21:00:00 31/12/2015] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 2.3 st: NotStopd t0: [21:00:00 31/12/2015] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [21:00:00 31/12/2015] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [21:00:00 31/12/2015] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [21:00:00 31/12/2015] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [21:00:00 31/12/2015] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [21:00:00 31/12/2015] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [21:00:00 31/12/2015] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [21:00:00 31/12/2015] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [21:00:00 31/12/2015] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.3 u1: L/min st: NotStopd t0: [21:00:00 31/12/2015] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [21:00:00 31/12/2015] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [21:00:00 31/12/2015] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [21:00:00 31/12/2015] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [21:00:00 31/12/2015] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [21:00:00 31/12/2015] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [21:00:00 31/12/2015] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [21:00:00 31/12/2015] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [21:00:00 31/12/2015] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [21:00:00 31/12/2015] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [21:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [21:00:00 31/12/2015] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [21:00:00 31/12/2015] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [21:00:00 31/12/2015] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 464 u1: ml/B st: NotStopd t0: [21:00:00 31/12/2015] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [21:00:00 31/12/2015] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 40 u1: ml/B st: NotStopd t0: [21:00:00 31/12/2015] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [21:00:00 31/12/2015] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [21:00:00 31/12/2015] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [21:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [21:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 161 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [21:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [21:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [21:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 15 u1: BPM st: NotStopd t0: [21:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [21:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 0 vu: ml st: Restart t0: [21:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [21:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [21:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [21:00:00 26/02/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Amiodarone HCl v1: 400 u1: mg
t0: [22:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 31/12/2015] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 31/12/2015] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [22:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [22:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [22:00:00 31/12/2015] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 31/12/2015] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 31/12/2015] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 147 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [22:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [22:00:00 31/12/2015] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 31/12/2015] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [22:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [22:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [22:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 31/12/2015] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [22:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 31/12/2015] tf: [14:00:00 07/01/2016] dt: 9600 id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [22:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [22:00:00 31/12/2015] tf: [08:00:00 06/01/2016] dt: 7800 id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [22:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [22:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:00:00 31/12/2015] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd
t0: [23:00:00 31/12/2015] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 31/12/2015] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 31/12/2015] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 31/12/2015] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 31/12/2015] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 31/12/2015] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 82 u1: BPM st: NotStopd t0: [23:00:00 31/12/2015] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 31/12/2015] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [23:00:00 31/12/2015] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [23:00:00 31/12/2015] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [23:00:00 31/12/2015] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [23:00:00 31/12/2015] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [23:00:00 31/12/2015] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [23:00:00 31/12/2015] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [23:00:00 31/12/2015] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [23:00:00 31/12/2015] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [23:00:00 31/12/2015] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 166 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [23:00:00 31/12/2015] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [23:00:00 31/12/2015] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 31/12/2015] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [23:00:00 31/12/2015] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [23:00:00 31/12/2015] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 31/12/2015] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 01/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 01/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 01/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 01/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 01/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [00:00:00 01/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 01/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [00:00:00 01/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [00:00:00 01/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 01/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [00:00:00 01/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 01/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 01/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 01/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 01/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 01/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 01/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 01/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 01/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 01/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 01/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [00:00:00 01/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 01/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 01/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 01/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 01/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 01/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 01/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 01/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 01/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 79 u1: BPM st: NotStopd t0: [00:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 01/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 01/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [00:00:00 01/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 01/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 01/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 01/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 01/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [00:00:00 01/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 01/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 01/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 01/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 01/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 01/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 01/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 01/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 01/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [00:00:00 01/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 01/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 01/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 01/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 162 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [00:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [00:00:00 01/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 01/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 01/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 01/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [00:00:00 01/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 01/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [00:00:00 01/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 01/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 01/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 01/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [00:00:00 01/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 01/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 01/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 01/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 01/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [00:00:00 01/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: White v2: Thick st: NotStopd t0: [00:00:00 01/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [00:00:00 01/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 01/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 01/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.7222 u1: Deg. C st: NotStopd t0: [00:00:00 01/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.3 u1: Deg. F st: NotStopd t0: [00:00:00 01/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 01/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 01/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 01/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 01/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 01/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [00:00:00 01/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [21:00:00 31/12/2015] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 30 vu: ml t0: [23:00:00 31/12/2015] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [23:00:00 31/12/2015] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [23:00:00 31/12/2015] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [23:00:00 31/12/2015] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [00:00:00 01/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 5 vu: ml t0: [00:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [00:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [00:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [00:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [23:00:00 31/12/2015] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [00:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [00:09:00 01/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.4 rs: Final st: NotStopd t0: [00:09:00 01/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 119 rs: Final st: NotStopd t0: [00:09:00 01/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.2 rs: Final st: NotStopd t0: [00:09:00 01/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: no data rs: Final st: NotStopd t0: [00:09:00 01/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: no data rs: Final st: NotStopd t0: [00:09:00 01/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 u1: mmHg rs: Final st: NotStopd t0: [00:09:00 01/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 u1: mmHg rs: Final st: NotStopd t0: [00:09:00 01/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.4 rs: Final st: NotStopd t0: [00:09:00 01/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 119 rs: Final st: NotStopd t0: [00:09:00 01/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.17 rs: Final st: NotStopd t0: [00:09:00 01/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.2 rs: Final st: NotStopd
t0: [01:00:00 01/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.1935 u1: ml/cmH st: NotStopd t0: [01:00:00 01/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [01:00:00 01/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [01:00:00 01/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [01:00:00 01/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [01:00:00 01/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [01:00:00 01/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 2.3 st: NotStopd t0: [01:00:00 01/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [01:00:00 01/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [01:00:00 01/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [01:00:00 01/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 01/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [01:00:00 01/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [01:00:00 01/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [01:00:00 01/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [01:00:00 01/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [01:00:00 01/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 01/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 01/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [01:00:00 01/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [01:00:00 01/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [01:00:00 01/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [01:00:00 01/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [01:00:00 01/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [01:00:00 01/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [01:00:00 01/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [01:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [01:00:00 01/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 459 u1: ml/B st: NotStopd t0: [01:00:00 01/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [01:00:00 01/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 35 u1: ml/B st: NotStopd t0: [01:00:00 01/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [01:00:00 01/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [01:00:00 01/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [01:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 01/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 01/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [01:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [01:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 134 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [01:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [01:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [01:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [01:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [01:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [01:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [01:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [01:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 01/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [02:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [02:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 137 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [02:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [02:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [02:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [02:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [02:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [02:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [02:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [02:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 01/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 90 cv: 90 ap: none t0: [23:00:00 01/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -22.6 cv: -22.6 ap: none t0: [23:00:00 01/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 17 cv: 1083 ap: none t0: [23:00:00 01/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 67.4 cv: 3024.6 ap: none t0: [23:00:00 01/01/2016] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 960 ap: none t0: [23:00:00 01/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 90 cv: 4545 ap: none t0: [23:00:00 01/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -22.6 cv: -1565.4 ap: carryForward t0: [23:00:00 01/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 90 cv: 4590 ap: carryForward t0: [23:00:00 01/01/2016] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 45 ap: none t0: [23:00:00 01/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -22.6 cv: 4021.94 ap: carryForward
t0: [03:38:00 01/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 108 rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 0.6 rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.3 rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 30 rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 124 u1: mmHg rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 108 rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.19 rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 0.6 rs: Final st: NotStopd t0: [03:38:00 01/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.3 rs: Final st: NotStopd
t0: [03:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 01/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 80 u1: BPM st: NotStopd t0: [03:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [03:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 150 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [03:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [03:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.6 u1: kg st: NotStopd t0: [03:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [03:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [03:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [03:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [03:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [03:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:00:00 01/01/2016] id: CVP el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [03:36:00 01/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 15.6 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 15.6 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 35.3 u1: % rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.8 u1: gm/dl rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 421 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.96 u1: /mic l rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 15.6 rs: Final st: NotStopd
t0: [03:36:00 01/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 13.7 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 41.8 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 13.7 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 41.8 rs: Final st: NotStopd
t0: [03:36:00 01/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 40 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.3 u1: mg/dl rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 101 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 112 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.4 u1: mEq/L rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.3 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 40 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.3 u1: mg/dl rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 29 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 101 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 112 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.4 u1: mEq/L rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.3 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd
t0: [02:00:00 01/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [02:00:00 01/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 01/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 01/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 01/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 01/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 01/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [04:00:00 01/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 01/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [04:00:00 01/01/2016] id: shampoo el: 0 cu: CSRU cg: RN v1: Done t0: [04:00:00 01/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [04:00:00 01/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 01/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 01/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 01/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 01/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 01/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 01/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 01/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 01/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 01/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 01/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 01/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 01/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [04:00:00 01/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 01/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 01/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 01/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 01/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 01/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 01/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 01/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 01/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 81 u1: BPM st: NotStopd t0: [04:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 01/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 01/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 01/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [04:00:00 01/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 01/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 01/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 01/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [04:00:00 01/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 01/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [04:00:00 01/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [04:00:00 01/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 01/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 01/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 01/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 01/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [04:00:00 01/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 01/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 01/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 01/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 01/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 01/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 01/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 01/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 01/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [04:00:00 01/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 01/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 01/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 165 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [04:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [04:00:00 01/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [04:00:00 01/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 01/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 01/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [04:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [04:00:00 01/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 01/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [04:00:00 01/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 01/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 01/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 01/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 17 u1: BPM st: NotStopd t0: [04:00:00 01/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 01/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 01/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 01/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 01/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 01/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 01/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [04:00:00 01/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.3333 u1: Deg. C st: NotStopd t0: [04:00:00 01/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 95.6 u1: Deg. F st: NotStopd t0: [04:00:00 01/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [04:00:00 01/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 01/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 01/01/2016] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.08277 u1: m2 st: NotStopd t0: [04:00:00 01/01/2016] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.26735 u1: m2 st: NotStopd t0: [04:00:00 01/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 01/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/01/2016] id: Weight Change el: 0 cu: CSRU cg: RN v1: 0 u1: kg st: NotStopd t0: [04:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 01/01/2016] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [04:00:00 01/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [04:00:00 01/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [04:00:00 01/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 01/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 01/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 01/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [04:00:00 01/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 16 u1: number st: NotStopd t0: [04:00:00 01/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 01/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [04:00:00 01/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 10 vu: ml t0: [04:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [04:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [04:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [04:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [04:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [05:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 01/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 01/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [05:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [05:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 155 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [05:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [05:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [05:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 7 u1: BPM st: NotStopd t0: [05:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [05:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 01/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [05:00:00 01/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [05:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [05:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [05:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [05:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [05:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [05:00:00 01/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 12.9412 u1: ml/cmH st: NotStopd t0: [05:00:00 01/01/2016] id: RSBI (<100) el: 0 cu: CSRU cg: RRT u1: units st: NotStopd t0: [05:00:00 01/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [05:00:00 01/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [05:00:00 01/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [05:00:00 01/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [05:00:00 01/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [05:00:00 01/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 2.3 st: NotStopd t0: [05:00:00 01/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:00:00 01/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [05:00:00 01/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [05:00:00 01/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 01/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 7 st: NotStopd t0: [05:00:00 01/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:00:00 01/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:00:00 01/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [05:00:00 01/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [05:00:00 01/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 01/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 01/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [05:00:00 01/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 39 u1: cmH2O st: NotStopd t0: [05:00:00 01/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [05:00:00 01/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [05:00:00 01/01/2016] id: RSBI (<200) el: 0 cu: CSRU cg: RRT u1: units st: NotStopd t0: [05:00:00 01/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [05:00:00 01/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [05:00:00 01/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [05:00:00 01/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [05:00:00 01/01/2016] id: Spon RR (Mech.) el: 0 cu: CSRU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [05:00:00 01/01/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: CSRU cg: RRT v1: 0.15 u1: L st: NotStopd t0: [05:00:00 01/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White v2: Thick st: NotStopd t0: [05:00:00 01/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [05:00:00 01/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 465 u1: ml/B st: NotStopd t0: [05:00:00 01/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [05:00:00 01/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 170 u1: ml/B st: NotStopd t0: [05:00:00 01/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [05:00:00 01/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [05:00:00 01/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [06:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 01/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 01/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [06:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9 t0: [06:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 147 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [06:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [06:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [06:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 1 u1: BPM st: NotStopd t0: [06:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [06:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [06:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [06:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [06:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [07:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [07:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 150 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [07:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [07:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [07:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 10 u1: BPM st: NotStopd t0: [07:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [07:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [07:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [07:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [07:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [07:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.9
t0: [07:15:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:15:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:15:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:15:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:15:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 101 u1: BPM st: NotStopd t0: [07:15:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [07:15:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 158 u1: mmHg v2: 92 u2: mmHg st: NotStopd t0: [07:15:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [07:15:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:15:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [07:15:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [07:15:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:15:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:15:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 01/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 16.2963 u1: ml/cmH st: NotStopd t0: [08:00:00 01/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [08:00:00 01/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 01/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 01/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:00:00 01/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [08:00:00 01/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.7 st: NotStopd t0: [08:00:00 01/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 01/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 01/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 01/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 01/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 01/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 8 v2: Albuterol st: NotStopd t0: [08:00:00 01/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 01/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 01/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.4 u1: L/min st: NotStopd t0: [08:00:00 01/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 01/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 01/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [08:00:00 01/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [08:00:00 01/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [08:00:00 01/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:00:00 01/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 12 u1: BPM st: NotStopd t0: [08:00:00 01/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 01/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [08:00:00 01/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 01/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [08:00:00 01/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 01/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:00:00 01/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:00:00 01/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 150 u1: ml/B st: NotStopd t0: [08:00:00 01/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [08:00:00 01/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 01/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RRT v1: Ins/Exp Wheeze st: NotStopd t0: [08:00:00 01/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RRT v1: Crackles st: NotStopd t0: [08:00:00 01/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RRT v1: Ins/Exp Wheeze st: NotStopd t0: [08:00:00 01/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RRT v1: Ins/Exp Wheeze st: NotStopd t0: [08:00:00 01/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RRT v1: Tachypneic st: NotStopd
t0: [07:00:00 01/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [07:00:00 01/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [07:00:00 01/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [07:00:00 01/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [07:00:00 01/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [07:00:00 01/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [07:00:00 01/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [07:00:00 01/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 01/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 01/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 01/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 01/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 01/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 01/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [08:00:00 01/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 01/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 01/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 01/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Pt Verbalized st: NotStopd t0: [08:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 01/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 01/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 01/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 01/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 01/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 01/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [08:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 01/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 01/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 01/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 01/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 01/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 01/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 01/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 01/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 01/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 01/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 01/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 01/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 01/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 98 u1: BPM st: NotStopd t0: [08:00:00 01/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [08:00:00 01/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 01/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 01/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 01/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 01/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 01/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 01/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 01/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [08:00:00 01/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 01/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 01/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 01/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 01/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 01/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 01/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 01/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 01/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [08:00:00 01/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 01/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 150 u1: mmHg v2: 91 u2: mmHg st: NotStopd t0: [08:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [08:00:00 01/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 01/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [08:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [08:00:00 01/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 01/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [08:00:00 01/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 01/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [08:00:00 01/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 01/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 01/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 01/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 01/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 01/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 01/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 01/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [08:00:00 01/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.2 u1: Deg. F st: NotStopd t0: [08:00:00 01/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 01/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 01/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 01/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 01/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [08:00:00 01/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 01/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 01/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 01/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 01/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [08:00:00 01/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 01/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [08:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [08:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [08:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [08:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [08:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:00:00 01/01/2016] id: Albumin 5% IV Infusions el: 1 cu: CSRU cg: -1 ai: 222 vo: 0 st: D/C'd
tf: [17:00:00 01/01/2016] pt: IV Piggyback rt: IV fr: INFUSION m1: Bumetanide v1: 12 u1: mg m2: D5W v2: 500 u2: ml tf: [21:00:00 01/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 9 dn: 1 m1: Amiodarone HCl v1: 150 u1: mg
t0: [09:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 99 u1: BPM st: NotStopd t0: [09:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [09:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [09:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 139 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [09:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [09:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [09:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [09:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [09:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [09:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [09:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [09:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:19:00 01/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 5 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 32 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 47 u1: mmHg rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 131 u1: mmHg rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd
t0: [09:19:00 01/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.4439 u1: ml/dl st: NotStopd t0: [09:19:00 01/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.2 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.19 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.2 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 97 u1: % rs: Final st: NotStopd
t0: [08:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd
t0: [03:36:00 01/01/2016] id: Total Bili Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: ALT Enzymes el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: AST Enzymes el: 0 cu: CSRU cg: 3161 v1: 21 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Alk. Phosphate Enzymes el: 0 cu: CSRU cg: 3161 v1: 185 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Amylase Enzymes el: 0 cu: CSRU cg: 3161 v1: 35 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: LDH Enzymes el: 0 cu: CSRU cg: 3161 v1: 162 rs: Final st: NotStopd t0: [03:36:00 01/01/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd
t0: [09:00:00 01/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 01/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 01/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 01/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 01/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 01/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [09:00:00 01/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [10:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 94 u1: BPM st: NotStopd t0: [10:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [10:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [10:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 129 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [10:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [10:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [10:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [10:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 01/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 20 vu: ml t0: [10:00:00 01/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [10:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [10:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [10:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [10:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [10:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:19:00 01/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.2 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Total Bili Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: ALT Enzymes el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: AST Enzymes el: 0 cu: CSRU cg: 3161 v1: 19 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Alk. Phosphate Enzymes el: 0 cu: CSRU cg: 3161 v1: 166 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Amylase Enzymes el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: LDH Enzymes el: 0 cu: CSRU cg: 3161 v1: 145 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.2 rs: Final st: NotStopd t0: [09:19:00 01/01/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd
t0: [10:21:00 01/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd
t0: [11:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 92 u1: BPM st: NotStopd t0: [11:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [11:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [11:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 131 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [11:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [11:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [11:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [11:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [11:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [11:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [11:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [11:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 01/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml
t0: [11:00:00 01/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml
t0: [11:23:00 01/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [11:23:00 01/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.6693 u1: ml/dl st: NotStopd t0: [11:23:00 01/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 5 rs: Final st: NotStopd t0: [11:23:00 01/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 31 rs: Final st: NotStopd t0: [11:23:00 01/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 46 u1: mmHg rs: Final st: NotStopd t0: [11:23:00 01/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 157 u1: mmHg rs: Final st: NotStopd t0: [11:23:00 01/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [11:23:00 01/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [11:34:00 01/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [11:34:00 01/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [11:34:00 01/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [11:34:00 01/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:34:00 01/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [11:34:00 01/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [11:34:00 01/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3.2 st: NotStopd t0: [11:34:00 01/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [11:34:00 01/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [11:34:00 01/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:34:00 01/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:34:00 01/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [11:34:00 01/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 8 v2: Albuterol st: NotStopd t0: [11:34:00 01/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:34:00 01/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [11:34:00 01/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.7 u1: L/min st: NotStopd t0: [11:34:00 01/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:34:00 01/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [11:34:00 01/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [11:34:00 01/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [11:34:00 01/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [11:34:00 01/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [11:34:00 01/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [11:34:00 01/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [11:34:00 01/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [11:34:00 01/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:34:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [11:34:00 01/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [11:34:00 01/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [11:34:00 01/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [11:34:00 01/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [11:34:00 01/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 150 u1: ml/B st: NotStopd t0: [11:34:00 01/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [11:34:00 01/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [11:20:00 01/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 43.1 rs: Final st: NotStopd t0: [11:20:00 01/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 43.1 rs: Final st: NotStopd
t0: [12:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 101 u1: BPM st: NotStopd t0: [12:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [12:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [12:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 137 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [12:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [12:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [12:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 48 u1: BPM st: NotStopd t0: [12:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [12:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [12:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [12:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [12:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:20:00 01/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd
t0: [08:00:00 01/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 01/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 01/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [12:00:00 01/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 01/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [12:00:00 01/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 01/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [12:00:00 01/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [12:00:00 01/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [12:00:00 01/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 01/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 01/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 01/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 01/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 01/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [12:00:00 01/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 01/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 01/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 01/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [12:00:00 01/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 01/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 01/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 01/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 01/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 01/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 01/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 01/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 01/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 01/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [12:00:00 01/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 01/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 01/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 01/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 01/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 01/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 01/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [12:00:00 01/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 01/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 01/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 01/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [12:00:00 01/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [12:00:00 01/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 01/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 01/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 01/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [12:00:00 01/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 01/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [12:00:00 01/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [12:00:00 01/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [12:00:00 01/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 01/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [12:00:00 01/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 01/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 01/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 01/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 01/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 01/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 01/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 01/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 01/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 01/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [12:00:00 01/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [12:00:00 01/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 01/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 01/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 01/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [12:00:00 01/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [12:00:00 01/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [13:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [13:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [13:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [13:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 152 u1: mmHg v2: 92 u2: mmHg st: NotStopd t0: [13:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg st: NotStopd t0: [13:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [13:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 42 u1: BPM st: NotStopd t0: [13:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 01/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 40 vu: ml t0: [13:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [13:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [13:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [13:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [13:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 01/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [12:00:00 01/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [12:00:00 01/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 01/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 01/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [12:00:00 01/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [12:00:00 01/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 01/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [13:00:00 01/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [13:00:00 01/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 01/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 01/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: Hoyer st: NotStopd t0: [13:00:00 01/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd
t0: [12:00:00 01/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml
t0: [13:18:00 01/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.1 rs: Final st: NotStopd t0: [13:18:00 01/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.1 rs: Final st: NotStopd
t0: [13:18:00 01/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 148 rs: Final st: NotStopd t0: [13:18:00 01/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: RN v1: 148 rs: Final st: NotStopd
t0: [14:00:00 01/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [14:00:00 01/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Agitated st: NotStopd t0: [14:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 165 u1: mmHg v2: 101 u2: mmHg st: NotStopd t0: [14:00:00 01/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [14:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [14:00:00 01/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [14:00:00 01/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [14:05:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:05:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:05:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:05:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:05:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [14:05:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:05:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 163 u1: mmHg v2: 89 u2: mmHg st: NotStopd t0: [14:05:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [14:05:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:05:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [14:05:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [14:05:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [14:05:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:05:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [14:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [14:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd
t0: [14:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [14:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [14:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [14:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [14:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [15:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [15:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [15:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 113 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [15:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [15:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [15:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [15:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [15:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [15:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [15:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 01/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 01/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [16:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [16:00:00 01/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 01/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 01/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 159 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [16:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [16:00:00 01/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [16:00:00 01/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 01/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [16:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [16:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [16:00:00 01/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 01/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [16:00:00 01/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [16:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [16:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [16:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 01/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 01/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [16:00:00 01/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [16:00:00 01/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 01/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [16:00:00 01/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 01/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 01/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 01/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 01/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 01/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [16:00:00 01/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 01/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 01/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 01/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [16:00:00 01/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 01/01/2016] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 01/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 01/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 01/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 01/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 01/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 01/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 01/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 01/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 01/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [16:00:00 01/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [16:00:00 01/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 01/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 01/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 01/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [16:00:00 01/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 01/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [16:00:00 01/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 01/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 01/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 01/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 01/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 01/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 01/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 01/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 01/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 01/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 01/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 01/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 01/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [16:00:00 01/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 01/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 01/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [16:00:00 01/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [16:00:00 01/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [16:00:00 01/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 01/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 01/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 01/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 01/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 01/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 01/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 01/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 01/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 01/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 01/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 01/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [16:00:00 01/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [16:00:00 01/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 01/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 01/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 01/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [16:00:00 01/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:30:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:30:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:30:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:30:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:30:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [16:30:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:30:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [16:30:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 160 u1: mmHg v2: 89 u2: mmHg st: NotStopd t0: [16:30:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [16:30:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:30:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [16:30:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [16:30:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:30:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 01/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [17:00:00 01/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd
t0: [16:30:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:00:00 01/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [13:00:00 01/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [17:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [17:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [17:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 162 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [17:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [17:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [17:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [17:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [17:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [17:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [17:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [17:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:50:00 01/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [17:50:00 01/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [17:50:00 01/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [17:50:00 01/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [17:50:00 01/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [17:50:00 01/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [17:50:00 01/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.7 st: NotStopd t0: [17:50:00 01/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:50:00 01/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [17:50:00 01/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:50:00 01/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:50:00 01/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [17:50:00 01/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:50:00 01/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [17:50:00 01/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [17:50:00 01/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.7 u1: L/min st: NotStopd t0: [17:50:00 01/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:50:00 01/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [17:50:00 01/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [17:50:00 01/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [17:50:00 01/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [17:50:00 01/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [17:50:00 01/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [17:50:00 01/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [17:50:00 01/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [17:50:00 01/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:50:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [17:50:00 01/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [17:50:00 01/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [17:50:00 01/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [17:50:00 01/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [17:50:00 01/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 110 u1: ml/B st: NotStopd t0: [17:50:00 01/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [17:50:00 01/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
tf: [11:00:00 02/01/2016] pt: IV Piggyback rt: IV fr: INFUSION dn: 1 m1: Bumetanide v1: 0.25 u1: mg m2: D5W v2: 500 u2: ml tf: [15:00:00 05/01/2016] pt: IV Piggyback rt: IV fr: ASDIR m1: Heparin Sodium v1: 25000 u1: UNIT m2: D5W v2: 250 u2: ml
t0: [18:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [18:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [18:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 148 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [18:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [18:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [18:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [18:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [18:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [18:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [18:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [18:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:13:00 01/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.6352 u1: ml/dl st: NotStopd t0: [18:13:00 01/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 125 rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.2 rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 30 rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 146 u1: mmHg rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 125 rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.11 rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.2 rs: Final st: NotStopd t0: [18:13:00 01/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [19:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 77 u1: BPM st: NotStopd t0: [19:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [19:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 164 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [19:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [19:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [19:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [19:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [19:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [19:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 38 vu: ml t0: [19:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [19:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [15:00:00 01/01/2016] tf: [17:00:00 01/01/2016] dt: 120 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml
t0: [18:00:00 01/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [18:00:00 01/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 01/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 01/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 01/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 01/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [18:00:00 01/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [18:00:00 01/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 01/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [18:00:00 01/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 01/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [19:00:00 01/01/2016] id: Procedures el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd
t0: [23:00:00 01/01/2016] dt: 24 id: Stool Out Total el: 3 cu: CSRU cg: RN cv: 0 ap: carryForward
t0: [20:00:00 01/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.75 u1: ml/cmH st: NotStopd t0: [20:00:00 01/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [20:00:00 01/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 01/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 01/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 01/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 01/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 01/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 01/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 01/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 01/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 01/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 01/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [20:00:00 01/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 01/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.7 u1: L/min st: NotStopd t0: [20:00:00 01/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 01/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 01/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [20:00:00 01/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 01/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:00:00 01/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [20:00:00 01/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [20:00:00 01/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [20:00:00 01/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:00:00 01/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [20:00:00 01/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 01/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 420 u1: ml/B st: NotStopd t0: [20:00:00 01/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 01/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 100 u1: ml/B st: NotStopd t0: [20:00:00 01/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [20:00:00 01/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 01/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 01/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 01/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 01/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 01/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 01/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [20:00:00 01/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [20:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 01/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 01/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 01/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 01/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 01/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 01/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 01/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 01/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 01/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 01/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 01/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 01/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 01/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 01/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 01/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 01/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 01/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 01/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 01/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [20:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 01/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [20:00:00 01/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 01/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 01/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 01/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 01/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 01/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 01/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 01/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [20:00:00 01/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 01/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 01/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 01/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 01/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 01/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 01/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 01/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 01/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 01/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 01/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [20:00:00 01/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Lethargic st: NotStopd t0: [20:00:00 01/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 01/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 01/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 168 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [20:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [20:00:00 01/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [20:00:00 01/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 01/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [20:00:00 01/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 01/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [20:00:00 01/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 01/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [20:00:00 01/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 01/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 01/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 01/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 01/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 01/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 01/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:00:00 01/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [20:00:00 01/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [20:00:00 01/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 01/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 01/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 01/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [20:00:00 01/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [20:00:00 01/01/2016] tf: [09:53:00 12/01/2016] dt: 15233 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [20:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [20:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [21:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [21:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [21:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 162 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [21:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [21:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [21:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [21:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [21:00:00 01/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml t0: [21:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [21:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 01/01/2016] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 180 ap: none
tf: [11:00:00 07/01/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 12.5 u1: mg
t0: [22:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [22:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [22:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 170 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [22:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [22:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [22:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [22:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [22:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [22:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:27:00 01/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 13.7 rs: Final st: NotStopd t0: [22:27:00 01/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [22:27:00 01/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 50.1 rs: Final st: NotStopd t0: [22:27:00 01/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [22:27:00 01/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 13.7 rs: Final st: NotStopd t0: [22:27:00 01/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 50.1 rs: Final st: NotStopd
t0: [23:00:00 01/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 01/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 01/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 01/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 01/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 01/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [23:00:00 01/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [23:00:00 01/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 01/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [23:00:00 01/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 01/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [23:00:00 01/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [23:00:00 01/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 166 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [23:00:00 01/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg st: NotStopd t0: [23:00:00 01/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [23:00:00 01/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [23:00:00 01/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 01/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [23:00:00 01/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [23:00:00 01/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [23:00:00 01/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 01/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [23:00:00 01/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [00:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [00:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 144 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [00:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [00:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [00:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [00:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 01/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [00:30:00 02/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 13.75 u1: ml/cmH st: NotStopd t0: [00:30:00 02/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [00:30:00 02/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:30:00 02/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:30:00 02/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:30:00 02/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [00:30:00 02/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:30:00 02/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:30:00 02/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:30:00 02/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:30:00 02/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [00:30:00 02/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:30:00 02/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:30:00 02/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.9 u1: L/min st: NotStopd t0: [00:30:00 02/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:30:00 02/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:30:00 02/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [00:30:00 02/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [00:30:00 02/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [00:30:00 02/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [00:30:00 02/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [00:30:00 02/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [00:30:00 02/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:30:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:30:00 02/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [00:30:00 02/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [00:30:00 02/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 425 u1: ml/B st: NotStopd t0: [00:30:00 02/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [00:30:00 02/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 150 u1: ml/B st: NotStopd t0: [00:30:00 02/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [00:30:00 02/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [00:30:00 02/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [01:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 02/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [01:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 02/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 02/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [01:00:00 02/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [01:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 168 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [01:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 117 u1: mmHg st: NotStopd t0: [01:00:00 02/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 02/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [01:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 02/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [01:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [01:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [01:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 02/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 01/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 01/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [23:00:00 01/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [00:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [00:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [01:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [01:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [00:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip t0: [01:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 02/01/2016] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 30 ap: none
t0: [01:00:00 02/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [01:00:00 02/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [01:00:00 02/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [01:00:00 02/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [01:00:00 02/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [01:00:00 02/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [01:00:00 02/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [01:00:00 02/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [01:00:00 02/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [01:00:00 02/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [01:00:00 02/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [01:00:00 02/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [01:00:00 02/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [01:00:00 02/01/2016] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [01:00:00 02/01/2016] id: Education Readiness el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 02/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Hypertension st: NotStopd t0: [01:00:00 02/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [01:00:00 02/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [01:00:00 02/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [01:00:00 02/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [01:00:00 02/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [01:00:00 02/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [01:00:00 02/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [01:00:00 02/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [01:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [01:00:00 02/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [01:00:00 02/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [01:00:00 02/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [01:00:00 02/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 02/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 02/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 02/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [01:00:00 02/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [01:00:00 02/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [01:00:00 02/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 02/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [01:00:00 02/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [01:00:00 02/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [01:00:00 02/01/2016] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [01:00:00 02/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [01:00:00 02/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [01:00:00 02/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 02/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [01:00:00 02/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [01:00:00 02/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [01:00:00 02/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 02/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [01:00:00 02/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [01:00:00 02/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [01:00:00 02/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [01:00:00 02/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [01:00:00 02/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [01:00:00 02/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [01:00:00 02/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [01:00:00 02/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [01:00:00 02/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [01:00:00 02/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [01:00:00 02/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 02/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [01:00:00 02/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [01:00:00 02/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [02:00:00 02/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [02:00:00 02/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [02:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 02/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Agitated st: NotStopd t0: [02:00:00 02/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [02:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [02:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [02:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [02:00:00 02/01/2016] id: Pain Cause el: 0 cu: CSRU cg: RN v1: Incisional st: NotStopd t0: [02:00:00 02/01/2016] id: Pain Location el: 0 cu: CSRU cg: RN v1: Incisional st: NotStopd t0: [02:00:00 02/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [02:00:00 02/01/2016] id: Pain Type el: 0 cu: CSRU cg: RN v1: Constant st: NotStopd t0: [02:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [02:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [02:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [02:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [02:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [02:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 02/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 120 cv: 120 ap: none t0: [23:00:00 02/01/2016] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 840 ap: none t0: [23:00:00 02/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 120 cv: 3570 ap: none t0: [23:00:00 02/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 120 cv: 3600 ap: carryForward
t0: [23:00:00 02/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -41.2 cv: -41.2 ap: none t0: [23:00:00 02/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 18 cv: 1031 ap: none t0: [23:00:00 02/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 78.8 cv: 2385 ap: none t0: [23:00:00 02/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -41.2 cv: -1215 ap: carryForward t0: [23:00:00 02/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -41.2 cv: 2806.94 ap: carryForward
t0: [02:44:00 02/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.47 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 92 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.4 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 7 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 32 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 43 u1: mmHg rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 169 u1: mmHg rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.47 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 92 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.16 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.4 rs: Final st: NotStopd t0: [02:44:00 02/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd
t0: [02:26:00 02/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.1 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 13.1 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 28.9 u1: % rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 9.4 u1: gm/dl rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 423 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.23 u1: /mic l rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.1 rs: Final st: NotStopd
t0: [03:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [03:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 146 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [03:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [03:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [03:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [03:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [03:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [03:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:26:00 02/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 37 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 102 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 94 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.2 u1: mEq/L rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.4 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 139 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 37 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 31 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 102 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 94 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.2 u1: mEq/L rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.4 rs: Final st: NotStopd t0: [02:26:00 02/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 139 rs: Final st: NotStopd
t0: [03:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [04:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [04:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [04:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [04:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [04:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [04:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [04:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [04:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [04:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [03:00:00 02/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [04:00:00 02/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml
t0: [05:00:00 02/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.6667 u1: ml/cmH st: NotStopd t0: [05:00:00 02/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [05:00:00 02/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [05:00:00 02/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [05:00:00 02/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [05:00:00 02/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [05:00:00 02/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:00:00 02/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [05:00:00 02/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:00:00 02/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 02/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [05:00:00 02/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:00:00 02/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [05:00:00 02/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 7.9 u1: L/min st: NotStopd t0: [05:00:00 02/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 02/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 02/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [05:00:00 02/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [05:00:00 02/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [05:00:00 02/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [05:00:00 02/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [05:00:00 02/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [05:00:00 02/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [05:00:00 02/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 460 u1: ml/B st: NotStopd t0: [05:00:00 02/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [05:00:00 02/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [05:00:00 02/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [05:00:00 02/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [05:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 02/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 62 u1: BPM st: NotStopd t0: [05:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [05:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 124 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [05:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [05:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [05:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [05:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [05:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [05:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [01:00:00 02/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Easily Palpable st: NotStopd t0: [06:00:00 02/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [06:00:00 02/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [06:00:00 02/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 02/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [06:00:00 02/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [06:00:00 02/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [06:00:00 02/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [06:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 02/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [06:00:00 02/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 02/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [06:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 02/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [06:00:00 02/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [06:00:00 02/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [06:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 02/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [06:00:00 02/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Hypertension st: NotStopd t0: [06:00:00 02/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 02/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [06:00:00 02/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [06:00:00 02/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [06:00:00 02/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [06:00:00 02/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [06:00:00 02/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [06:00:00 02/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [06:00:00 02/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [06:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [06:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 02/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [06:00:00 02/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [06:00:00 02/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [06:00:00 02/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [06:00:00 02/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [06:00:00 02/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [06:00:00 02/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [06:00:00 02/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [06:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [06:00:00 02/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 02/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 02/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [06:00:00 02/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [06:00:00 02/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [06:00:00 02/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 02/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 02/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 02/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [06:00:00 02/01/2016] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [06:00:00 02/01/2016] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [06:00:00 02/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [06:00:00 02/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [06:00:00 02/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [06:00:00 02/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 02/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 02/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [06:00:00 02/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [06:00:00 02/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 02/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [06:00:00 02/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [06:00:00 02/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 167 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [06:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [06:00:00 02/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 02/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 02/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Easily Palpable st: NotStopd t0: [06:00:00 02/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 02/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 63.6 u1: kg st: NotStopd t0: [06:00:00 02/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [06:00:00 02/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [06:00:00 02/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 02/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 02/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 02/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 02/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [06:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 17 u1: BPM st: NotStopd t0: [06:00:00 02/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 02/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 02/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 02/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 02/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 02/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [06:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 02/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [06:00:00 02/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [06:00:00 02/01/2016] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden v2: Other/Remarks st: NotStopd t0: [06:00:00 02/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [06:00:00 02/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 02/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [06:00:00 02/01/2016] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.07894 u1: m2 st: NotStopd t0: [06:00:00 02/01/2016] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.26297 u1: m2 st: NotStopd t0: [06:00:00 02/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [06:00:00 02/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [06:00:00 02/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 02/01/2016] id: Weight Change el: 0 cu: CSRU cg: RN v1: -0.4 u1: kg st: NotStopd t0: [06:00:00 02/01/2016] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [06:00:00 02/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [06:00:00 02/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [07:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [07:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [07:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 181 u1: mmHg v2: 92 u2: mmHg st: NotStopd t0: [07:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 125 u1: mmHg st: NotStopd t0: [07:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [07:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [07:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 02/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [07:00:00 02/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [07:00:00 02/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [07:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [06:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [06:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip t0: [07:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [07:00:00 02/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [07:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [07:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [20:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [21:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [22:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [23:00:00 01/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [00:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [01:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [02:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [03:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [04:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [05:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [06:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [07:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml
t0: [08:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [08:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [08:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [08:00:00 02/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.7143 u1: ml/cmH st: NotStopd t0: [08:00:00 02/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [08:00:00 02/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 02/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 02/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:00:00 02/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [08:00:00 02/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.7 st: NotStopd t0: [08:00:00 02/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 02/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 02/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [08:00:00 02/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 02/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 02/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 02/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 02/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 02/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.6 u1: L/min st: NotStopd t0: [08:00:00 02/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 02/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 02/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [08:00:00 02/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [08:00:00 02/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [08:00:00 02/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [08:00:00 02/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [08:00:00 02/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [08:00:00 02/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [08:00:00 02/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 02/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:00:00 02/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:00:00 02/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 450 u1: ml/B st: NotStopd t0: [08:00:00 02/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [08:00:00 02/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 02/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [06:35:00 02/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.1 rs: Final st: NotStopd t0: [06:35:00 02/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [06:35:00 02/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 64.3 rs: Final st: NotStopd t0: [06:35:00 02/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [06:35:00 02/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.1 rs: Final st: NotStopd t0: [06:35:00 02/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 64.3 rs: Final st: NotStopd
t0: [06:00:00 02/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 02/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 02/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 02/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 02/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 02/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 02/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 02/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 02/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 02/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 02/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 02/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 02/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 02/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 02/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 02/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Hypertension st: NotStopd t0: [08:00:00 02/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 02/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 02/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 02/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 02/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 02/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 02/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 02/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 02/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [08:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 02/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 02/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 02/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 02/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 02/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 02/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 02/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 02/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 02/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 02/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 02/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 02/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 02/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 02/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 02/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [08:00:00 02/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 02/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 02/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 02/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [08:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [08:00:00 02/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [08:00:00 02/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 02/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 02/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 02/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [08:00:00 02/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 02/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [08:00:00 02/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 02/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 02/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 02/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [08:00:00 02/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 02/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 02/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 02/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 02/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 02/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 02/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 02/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 02/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 02/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 02/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [09:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [09:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 158 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [09:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [09:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [09:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 13 u1: BPM st: NotStopd t0: [09:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 02/01/2016] tf: [08:00:00 03/01/2016] dt: 1380 id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 5 vu: ml t0: [09:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [09:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [09:00:00 02/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml t0: [09:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [08:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip t0: [09:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [10:00:00 02/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [10:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 02/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [10:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 02/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [10:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 02/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [10:00:00 02/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [10:00:00 02/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [10:00:00 02/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [10:00:00 02/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [10:00:00 02/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [10:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 64 u1: BPM st: NotStopd t0: [10:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 02/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [10:00:00 02/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [10:00:00 02/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [10:00:00 02/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [10:00:00 02/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [10:00:00 02/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 144 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [10:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [10:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 02/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [10:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [10:00:00 02/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [10:00:00 02/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [10:00:00 02/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [10:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [10:00:00 02/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 02/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [10:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 02/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [10:00:00 02/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [10:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [10:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [10:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [10:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [10:00:00 02/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [10:00:00 02/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [10:00:00 02/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd
t0: [08:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [09:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [10:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [10:00:00 02/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Restraint DC'd st: NotStopd t0: [11:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 63 u1: BPM st: NotStopd t0: [11:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [11:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 135 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [11:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [11:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [11:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 5 u1: BPM st: NotStopd t0: [11:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [11:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [11:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [11:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 02/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 16.2963 u1: ml/cmH st: NotStopd t0: [11:00:00 02/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [11:00:00 02/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [11:00:00 02/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:00:00 02/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [11:00:00 02/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [11:00:00 02/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.7 st: NotStopd t0: [11:00:00 02/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [11:00:00 02/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [11:00:00 02/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [11:00:00 02/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:00:00 02/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [11:00:00 02/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:00:00 02/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:00:00 02/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [11:00:00 02/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 12.2 u1: L/min st: NotStopd t0: [11:00:00 02/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 02/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 02/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [11:00:00 02/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [11:00:00 02/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [11:00:00 02/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [11:00:00 02/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [11:00:00 02/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [11:00:00 02/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 02/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [11:00:00 02/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [11:00:00 02/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 139 u1: ml/B st: NotStopd t0: [11:00:00 02/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [11:00:00 02/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [11:00:00 02/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
tf: [08:00:00 04/01/2016] pt: IV Piggyback rt: IV fr: INFUSION m1: Bumetanide v1: 12 u1: mg m2: D5W v2: 500 u2: ml
t0: [11:57:00 02/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.44 rs: Final st: NotStopd t0: [11:57:00 02/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 7 rs: Final st: NotStopd t0: [11:57:00 02/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 33 rs: Final st: NotStopd t0: [11:57:00 02/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 47 u1: mmHg rs: Final st: NotStopd t0: [11:57:00 02/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 154 u1: mmHg rs: Final st: NotStopd t0: [11:57:00 02/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.44 rs: Final st: NotStopd
t0: [10:00:00 02/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [10:00:00 02/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [10:00:00 02/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [10:00:00 02/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [10:00:00 02/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [10:00:00 02/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [10:00:00 02/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [10:00:00 02/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [10:00:00 02/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [10:00:00 02/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [12:00:00 02/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [12:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 02/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 02/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 02/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 02/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 02/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 02/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [12:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [12:00:00 02/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [12:00:00 02/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [12:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 126 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [12:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [12:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 02/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [12:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [12:00:00 02/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [12:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 02/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 02/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 124 rs: Manual st: NotStopd
t0: [12:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [12:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [12:00:00 02/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 30 vu: ml t0: [12:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [12:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 02/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 02/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [12:00:00 02/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 02/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [12:00:00 02/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 02/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 02/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 02/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [12:00:00 02/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 02/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 02/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 02/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 02/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 02/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [12:00:00 02/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [12:00:00 02/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 02/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [12:00:00 02/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [13:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [13:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [13:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [12:00:00 02/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [12:00:00 02/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [13:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 144 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [13:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [13:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [13:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [13:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 02/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [14:00:00 02/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [14:00:00 02/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 02/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [14:00:00 02/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [14:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 02/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [14:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 02/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [14:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 02/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 02/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [14:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 02/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 02/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [14:00:00 02/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [14:00:00 02/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 02/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [14:00:00 02/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [14:00:00 02/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [14:00:00 02/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [14:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 02/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [14:00:00 02/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [14:00:00 02/01/2016] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [14:00:00 02/01/2016] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [14:00:00 02/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [14:00:00 02/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 02/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 02/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [14:00:00 02/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 02/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 02/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 02/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [14:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [14:00:00 02/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 02/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 02/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [14:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [14:00:00 02/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [14:00:00 02/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [14:00:00 02/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 02/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 02/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [14:00:00 02/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 02/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [14:00:00 02/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [15:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [15:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 02/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [15:00:00 02/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [15:00:00 02/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [15:00:00 02/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [15:00:00 02/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 02/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [15:00:00 02/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [15:00:00 02/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [15:00:00 02/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 02/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [15:00:00 02/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 167 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [15:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [15:00:00 02/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [15:00:00 02/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 02/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [15:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [15:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 6 u1: BPM st: NotStopd t0: [15:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [14:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [14:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [15:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [15:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [15:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [13:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip t0: [14:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip t0: [15:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 02/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 02/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [14:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [15:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [16:00:00 02/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 02/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [16:00:00 02/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 02/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [16:00:00 02/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 02/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 02/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 02/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 02/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 02/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 02/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 02/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 02/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 02/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 02/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 02/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 64 u1: BPM st: NotStopd t0: [16:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 02/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [16:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [16:00:00 02/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 02/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 02/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [16:00:00 02/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 163 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [16:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [16:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [16:00:00 02/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 02/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 02/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 17 u1: BPM st: NotStopd t0: [16:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 02/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [16:00:00 02/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [16:00:00 02/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [16:00:00 02/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 02/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 02/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [16:00:00 02/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [16:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [16:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [16:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [16:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 02/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 16.2963 u1: ml/cmH st: NotStopd t0: [16:00:00 02/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [16:00:00 02/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:00:00 02/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 02/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [16:00:00 02/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [16:00:00 02/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.7 st: NotStopd t0: [16:00:00 02/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:00:00 02/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [16:00:00 02/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [16:00:00 02/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 02/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 02/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 02/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 02/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:00:00 02/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 14 u1: L/min st: NotStopd t0: [16:00:00 02/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 02/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 02/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [16:00:00 02/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [16:00:00 02/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [16:00:00 02/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [16:00:00 02/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [16:00:00 02/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [16:00:00 02/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [16:00:00 02/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 02/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [16:00:00 02/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [16:00:00 02/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 130 u1: ml/B st: NotStopd t0: [16:00:00 02/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [16:00:00 02/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 02/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [17:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [17:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [17:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 150 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [17:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [17:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [17:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [17:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [17:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [17:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [17:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 02/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 02/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 02/01/2016] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden v2: Soft st: NotStopd t0: [17:00:00 02/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bed as Chair st: NotStopd t0: [17:00:00 02/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd
t0: [23:00:00 02/01/2016] dt: 24 id: Stool Out Total el: 3 cu: CSRU cg: RN cv: 0 ap: carryForward
t0: [17:00:00 02/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 02/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [18:00:00 02/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [18:00:00 02/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [18:00:00 02/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [18:00:00 02/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [18:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 02/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [18:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 02/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [18:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 02/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [18:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 02/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [18:00:00 02/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [18:00:00 02/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [18:00:00 02/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [18:00:00 02/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [18:00:00 02/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [18:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [18:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 02/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [18:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [18:00:00 02/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [18:00:00 02/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 02/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Dozing Intermit st: NotStopd t0: [18:00:00 02/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [18:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 155 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [18:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [18:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [18:00:00 02/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [18:00:00 02/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 02/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [18:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 13 u1: BPM st: NotStopd t0: [18:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 02/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [18:00:00 02/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [18:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 02/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 140 rs: Manual st: NotStopd t0: [18:00:00 02/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [18:00:00 02/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [18:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [18:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [18:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [18:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 02/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [20:00:00 02/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [20:00:00 02/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 02/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 02/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 02/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 02/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.7 st: NotStopd t0: [20:00:00 02/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 02/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 02/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [20:00:00 02/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 02/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 02/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 02/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 02/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [20:00:00 02/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [20:00:00 02/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 02/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 02/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [20:00:00 02/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 02/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:00:00 02/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [20:00:00 02/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [20:00:00 02/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [20:00:00 02/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [20:00:00 02/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [20:00:00 02/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 02/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 448 u1: ml/B st: NotStopd t0: [20:00:00 02/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 02/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 115 u1: ml/B st: NotStopd t0: [20:00:00 02/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [20:00:00 02/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 02/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [19:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [19:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [19:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 158 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [19:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [19:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [19:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [19:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 02/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 02/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 02/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [20:00:00 02/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 02/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 02/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 02/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [20:00:00 02/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [20:00:00 02/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 02/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [20:00:00 02/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 02/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 02/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 02/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 02/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 02/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 02/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 02/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 02/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 02/01/2016] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [20:00:00 02/01/2016] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [20:00:00 02/01/2016] id: Education Readiness el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 02/01/2016] id: Education Response el: 0 cu: CSRU cg: RN v1: Understands st: NotStopd t0: [20:00:00 02/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 02/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 02/01/2016] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 02/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 02/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 02/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 02/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 02/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 02/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 02/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 02/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 02/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [20:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 02/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [20:00:00 02/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 02/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 02/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 02/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 02/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 02/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 02/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [20:00:00 02/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [20:00:00 02/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 02/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 02/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 02/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 02/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 02/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [20:00:00 02/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 02/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 02/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Transparent v2: Intact st: NotStopd t0: [20:00:00 02/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 02/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 02/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 02/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 02/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 02/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [20:00:00 02/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 02/01/2016] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [20:00:00 02/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 02/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 02/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 164 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [20:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [20:00:00 02/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [20:00:00 02/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 02/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Doppler st: NotStopd t0: [20:00:00 02/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [20:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [20:00:00 02/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 02/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 02/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 02/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 02/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [20:00:00 02/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 02/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 02/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 02/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 02/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 02/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 02/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:00:00 02/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [20:00:00 02/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [20:00:00 02/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [20:00:00 02/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [20:00:00 02/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 02/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 02/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [20:00:00 02/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [20:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 26 vu: ml t0: [20:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml
t0: [19:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [21:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [21:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [21:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 177 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [21:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg st: NotStopd t0: [21:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [21:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [21:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 02/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml t0: [21:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [21:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml
t0: [21:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 02/01/2016] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 150 ap: none
t0: [22:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 64 u1: BPM st: NotStopd t0: [22:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [22:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 156 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [22:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [22:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [22:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 13 u1: BPM st: NotStopd t0: [22:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [22:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [22:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [22:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 02/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 02/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 02/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 02/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 02/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 02/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 61 u1: BPM st: NotStopd t0: [23:00:00 02/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 02/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 127 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [23:00:00 02/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [23:00:00 02/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 02/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [23:00:00 02/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 15 u1: BPM st: NotStopd t0: [23:00:00 02/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 02/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vu: ml t0: [21:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vu: ml t0: [23:00:00 02/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 02/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [23:00:00 02/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [23:00:00 02/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [23:00:00 02/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [00:00:00 03/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 16.2963 u1: ml/cmH st: NotStopd t0: [00:00:00 03/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 18 t0: [00:00:00 03/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 03/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 03/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 03/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [00:00:00 03/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 03/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 03/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [00:00:00 03/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 03/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 03/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 03/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 03/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [00:00:00 03/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [00:00:00 03/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 03/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 03/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [00:00:00 03/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 03/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [00:00:00 03/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [00:00:00 03/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [00:00:00 03/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [00:00:00 03/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 03/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [00:00:00 03/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [00:00:00 03/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 425 u1: ml/B st: NotStopd t0: [00:00:00 03/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [00:00:00 03/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 245 u1: ml/B st: NotStopd t0: [00:00:00 03/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [00:00:00 03/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 03/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [23:00:00 02/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [00:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 03/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [00:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [00:00:00 03/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 03/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 165 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [00:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [00:00:00 03/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 03/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [00:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [00:00:00 03/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 03/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 03/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [01:00:00 03/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [01:00:00 03/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [01:00:00 03/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [01:00:00 03/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [01:00:00 03/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [01:00:00 03/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [01:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 03/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [01:00:00 03/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [01:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 03/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [01:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 03/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [01:00:00 03/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [01:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 03/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [01:00:00 03/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [01:00:00 03/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [01:00:00 03/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [01:00:00 03/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [01:00:00 03/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [01:00:00 03/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [01:00:00 03/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [01:00:00 03/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [01:00:00 03/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [01:00:00 03/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [01:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [01:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 03/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [01:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [01:00:00 03/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: CSRU cg: RN v1: Soap & H20 st: NotStopd t0: [01:00:00 03/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 03/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 03/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [01:00:00 03/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Pink st: NotStopd t0: [01:00:00 03/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [01:00:00 03/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [01:00:00 03/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [01:00:00 03/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 03/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 03/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [01:00:00 03/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [01:00:00 03/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [01:00:00 03/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 03/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [01:00:00 03/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [01:00:00 03/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [01:00:00 03/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [01:00:00 03/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 165 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [01:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [01:00:00 03/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [01:00:00 03/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [01:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [01:00:00 03/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 03/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [01:00:00 03/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [01:00:00 03/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [01:00:00 03/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [01:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 15 u1: BPM st: NotStopd t0: [01:00:00 03/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [01:00:00 03/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [01:00:00 03/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [01:00:00 03/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [01:00:00 03/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [01:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 03/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [01:00:00 03/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [01:00:00 03/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 03/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [01:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 03/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [01:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 26 vu: ml t0: [01:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [01:00:00 03/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 50 vu: ml t0: [01:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 80 vu: ml
t0: [00:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip t0: [01:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 03/01/2016] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 180 ap: none t0: [23:00:00 03/01/2016] dt: 24 id: Stool Out Total el: 3 cu: CSRU cg: RN cv: 0 ap: carryForward
t0: [02:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [02:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [02:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 158 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [02:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [02:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [02:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 41 u1: BPM st: NotStopd t0: [02:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [02:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [02:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [02:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [02:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 03/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 220 cv: 220 ap: none t0: [23:00:00 03/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: 7.8 cv: 7.8 ap: none t0: [23:00:00 03/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 167 cv: 1365 ap: none t0: [23:00:00 03/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 227.8 cv: 2983.4 ap: none t0: [23:00:00 03/01/2016] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 960 ap: none t0: [23:00:00 03/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 220 cv: 3276 ap: none t0: [23:00:00 03/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: 7.8 cv: -292.6 ap: carryForward t0: [23:00:00 03/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 220 cv: 3276 ap: carryForward t0: [23:00:00 03/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: 7.8 cv: 2514.34 ap: carryForward
t0: [03:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [03:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [03:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 128 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [03:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [03:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [03:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [03:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 03/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [04:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 03/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [04:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 03/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 03/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 03/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 03/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 03/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 03/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 03/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [04:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [04:00:00 03/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 128 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [04:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [04:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [04:00:00 03/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [04:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 03/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [03:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [03:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [04:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [04:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [04:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [03:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip t0: [04:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [00:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd
t0: [04:00:00 03/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [04:00:00 03/01/2016] id: RSBI Not Completed el: 0 cu: CSRU cg: RRT v1: Other/Remarks st: NotStopd t0: [04:00:00 03/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 20 t0: [04:00:00 03/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 03/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 03/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 03/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [04:00:00 03/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3.2 st: NotStopd t0: [04:00:00 03/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 03/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 03/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [04:00:00 03/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 03/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 03/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 03/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 03/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [04:00:00 03/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.3 u1: L/min st: NotStopd t0: [04:00:00 03/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 03/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 03/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [04:00:00 03/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [04:00:00 03/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [04:00:00 03/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [04:00:00 03/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [04:00:00 03/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [04:00:00 03/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 03/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 473 u1: ml/B st: NotStopd t0: [04:00:00 03/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [04:00:00 03/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 139 u1: ml/B st: NotStopd t0: [04:00:00 03/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [04:00:00 03/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 03/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [04:33:00 03/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.46 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 10 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 36 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 49 u1: mmHg rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 141 u1: mmHg rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.46 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.16 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd
t0: [02:49:00 03/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 15.6 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 15.6 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 32.8 u1: % rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10 u1: gm/dl rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 535 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.6 u1: /mic l rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 15.6 rs: Final st: NotStopd
t0: [02:49:00 03/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.2 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 90.8 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.2 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 90.8 rs: Final st: NotStopd
t0: [02:49:00 03/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 30 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 109 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.8 u1: mEq/L rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 30 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 30 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 109 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.8 u1: mEq/L rs: Final st: NotStopd
t0: [02:49:00 03/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 7.9 u1: mg/dl rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 100 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 139 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 7.9 u1: mg/dl rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 100 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 139 rs: Final st: NotStopd
t0: [02:49:00 03/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.8 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.8 rs: Final st: NotStopd
t0: [00:00:00 03/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 03/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Pt Verbalized st: NotStopd t0: [00:00:00 03/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 03/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 03/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [01:00:00 03/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN st: NotStopd t0: [04:00:00 03/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 03/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Pt Verbalized st: NotStopd t0: [04:00:00 03/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:33:00 03/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 3 rs: Final st: NotStopd t0: [04:33:00 03/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 3 rs: Final st: NotStopd t0: [05:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [05:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [05:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 134 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [05:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [05:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [05:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [05:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 03/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [05:00:00 03/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [05:00:00 03/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [05:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 03/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [06:00:00 03/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [06:00:00 03/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [06:00:00 03/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 03/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 03/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [06:00:00 03/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [06:00:00 03/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [06:00:00 03/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Pt Verbalized st: NotStopd t0: [06:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 03/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [06:00:00 03/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 03/01/2016] id: Cough/Deep Breathe el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 03/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [06:00:00 03/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [06:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 03/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [06:00:00 03/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [06:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 03/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [06:00:00 03/01/2016] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [06:00:00 03/01/2016] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [06:00:00 03/01/2016] id: Education Readiness el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 03/01/2016] id: Education Response el: 0 cu: CSRU cg: RN v1: Understands st: NotStopd t0: [06:00:00 03/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [06:00:00 03/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 03/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [06:00:00 03/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [06:00:00 03/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [06:00:00 03/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [06:00:00 03/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [06:00:00 03/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [06:00:00 03/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [06:00:00 03/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [06:00:00 03/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [06:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [06:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 03/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [06:00:00 03/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [06:00:00 03/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [06:00:00 03/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [06:00:00 03/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [06:00:00 03/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [06:00:00 03/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [06:00:00 03/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [06:00:00 03/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [06:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [06:00:00 03/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 03/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 03/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 03/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [06:00:00 03/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Pink st: NotStopd t0: [06:00:00 03/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [06:00:00 03/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [06:00:00 03/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [06:00:00 03/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 03/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 03/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 03/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [06:00:00 03/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [06:00:00 03/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [06:00:00 03/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [06:00:00 03/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [06:00:00 03/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [06:00:00 03/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [06:00:00 03/01/2016] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: C Surg RN st: NotStopd t0: [06:00:00 03/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 03/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [06:00:00 03/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 2 st: NotStopd t0: [06:00:00 03/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 151 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [06:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [06:00:00 03/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [06:00:00 03/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 03/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [06:00:00 03/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [06:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 03/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [06:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [06:00:00 03/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [06:00:00 03/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [06:00:00 03/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 03/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 03/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [06:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 03/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [06:00:00 03/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 03/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 03/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 03/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 03/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [06:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 03/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [06:00:00 03/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [06:00:00 03/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [06:00:00 03/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [06:00:00 03/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [06:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 03/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [06:00:00 03/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [05:00:00 03/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [05:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [05:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [05:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [06:00:00 03/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [06:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 13 vu: ml t0: [06:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [06:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [05:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1300 du: Uhr sv: 250 su: ml rt: IV Drip t0: [06:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [07:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [07:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 149 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [07:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [07:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [07:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [07:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [07:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [07:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [07:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [07:00:00 03/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 16.9231 u1: ml/cmH st: NotStopd t0: [07:00:00 03/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 20 t0: [07:00:00 03/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [07:00:00 03/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [07:00:00 03/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [07:00:00 03/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [07:00:00 03/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3.2 st: NotStopd t0: [07:00:00 03/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [07:00:00 03/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [07:00:00 03/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [07:00:00 03/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:00:00 03/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [07:00:00 03/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:00:00 03/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:00:00 03/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [07:00:00 03/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 7.7 u1: L/min st: NotStopd t0: [07:00:00 03/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:00:00 03/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [07:00:00 03/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [07:00:00 03/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [07:00:00 03/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [07:00:00 03/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [07:00:00 03/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [07:00:00 03/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [07:00:00 03/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [07:00:00 03/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [07:00:00 03/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [07:00:00 03/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [07:00:00 03/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 84 u1: ml/B st: NotStopd t0: [07:00:00 03/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [07:00:00 03/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [07:00:00 03/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 03/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: -1 st: D/C'd t0: [08:00:00 03/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: -1 st: D/C'd
tf: [07:00:00 04/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 8 dn: 1 m1: Midazolam HCl v1: 1 u1: mg
t0: [08:00:00 03/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 03/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Agitated st: NotStopd t0: [08:00:00 03/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 03/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 03/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [08:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [08:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 160 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [08:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [08:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [08:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 6 u1: BPM st: NotStopd t0: [08:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 03/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 03/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [08:00:00 03/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [08:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 03/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [08:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [08:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [08:00:00 03/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 40 vu: ml t0: [08:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [08:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 03/01/2016] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 0 ap: none
t0: [08:00:00 03/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 03/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 03/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 03/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 03/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 03/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 03/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 03/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 03/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [08:00:00 03/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 03/01/2016] id: Cough/Deep Breathe el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 03/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 03/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 03/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 03/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 03/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 03/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 03/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 03/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 03/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 03/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 03/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 03/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 03/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 03/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [08:00:00 03/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 03/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 03/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 03/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 03/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 03/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [08:00:00 03/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 03/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 03/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 03/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 03/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Pink st: NotStopd t0: [08:00:00 03/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 03/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 03/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [08:00:00 03/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 03/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 03/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 03/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 03/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 03/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 03/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 03/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 03/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [08:00:00 03/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 03/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 03/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 03/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 03/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [08:00:00 03/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 03/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 03/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 03/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 03/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 03/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 03/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 03/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 03/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 03/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 03/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 03/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 03/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 03/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 03/01/2016] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Brown v2: Soft st: NotStopd t0: [08:00:00 03/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [08:00:00 03/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 03/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 03/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 03/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 03/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [08:00:00 03/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 03/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 03/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 03/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 03/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [08:00:00 03/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 03/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [09:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [09:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [09:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 156 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [09:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [09:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [09:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [09:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [09:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [09:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [09:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [09:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:17:00 03/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.46 rs: Final st: NotStopd t0: [09:17:00 03/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 7 rs: Final st: NotStopd t0: [09:17:00 03/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 33 rs: Final st: NotStopd t0: [09:17:00 03/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [09:17:00 03/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 145 u1: mmHg rs: Final st: NotStopd t0: [09:17:00 03/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.46 rs: Final st: NotStopd
t0: [10:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 62 u1: BPM st: NotStopd t0: [10:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [10:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 117 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [10:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [10:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [10:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [10:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [10:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [10:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [10:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:17:00 03/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 2.8 rs: Final st: NotStopd t0: [09:17:00 03/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: RN v1: 1.06 rs: Final st: NotStopd t0: [09:17:00 03/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 2.8 rs: Final st: NotStopd t0: [10:30:00 03/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [10:30:00 03/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [10:30:00 03/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd
t0: [11:00:00 03/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 12.5714 u1: ml/cmH st: NotStopd t0: [11:00:00 03/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 20 t0: [11:00:00 03/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [11:00:00 03/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:00:00 03/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [11:00:00 03/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [11:00:00 03/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [11:00:00 03/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [11:00:00 03/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [11:00:00 03/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:00:00 03/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [11:00:00 03/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [11:00:00 03/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9 u1: L/min st: NotStopd t0: [11:00:00 03/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 03/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 03/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [11:00:00 03/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [11:00:00 03/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [11:00:00 03/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [11:00:00 03/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [11:00:00 03/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [11:00:00 03/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [11:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [11:00:00 03/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [11:00:00 03/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [11:00:00 03/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 80 u1: ml/B st: NotStopd t0: [11:00:00 03/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [11:00:00 03/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [11:00:00 03/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [11:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [11:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [11:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 160 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [11:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [11:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [11:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 40 u1: BPM st: NotStopd t0: [11:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [11:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [11:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [11:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:30:00 03/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 14 u1: BPM st: NotStopd
t0: [08:00:00 03/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: White v2: Thick st: NotStopd t0: [08:00:00 03/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [12:00:00 03/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 03/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 03/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [12:00:00 03/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 03/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 03/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [12:00:00 03/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [12:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 03/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [12:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 03/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 03/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 03/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 03/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 03/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 03/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 03/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 03/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 03/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 03/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 03/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 03/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 03/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 03/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 03/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [12:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 03/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [12:00:00 03/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [12:00:00 03/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 03/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 03/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [12:00:00 03/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 03/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [12:00:00 03/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [12:00:00 03/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [12:00:00 03/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 03/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 03/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Pink st: NotStopd t0: [12:00:00 03/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 03/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 03/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [12:00:00 03/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 03/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 03/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 03/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [12:00:00 03/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 03/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 03/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 03/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 03/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [12:00:00 03/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 03/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 03/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 151 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [12:00:00 03/01/2016] id: Pain Location el: 0 cu: CSRU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 03/01/2016] id: Pain Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [12:00:00 03/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [12:00:00 03/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 03/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 03/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [12:00:00 03/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 03/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: White v2: Thick st: NotStopd t0: [12:00:00 03/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [12:00:00 03/01/2016] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Brown v2: Soft st: NotStopd t0: [12:00:00 03/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 03/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [12:00:00 03/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [12:00:00 03/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 03/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 03/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 03/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 144 rs: Manual st: NotStopd t0: [12:00:00 03/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [12:00:00 03/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [12:00:00 03/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [12:00:00 03/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [12:00:00 03/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [12:00:00 03/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [12:00:00 03/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [12:00:00 03/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [12:00:00 03/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [12:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [12:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [12:00:00 03/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 30 vu: ml t0: [12:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [12:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:21:00 03/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.39 rs: Final st: NotStopd t0: [12:21:00 03/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 7 rs: Final st: NotStopd t0: [12:21:00 03/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 35 rs: Final st: NotStopd t0: [12:21:00 03/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 55 u1: mmHg rs: Final st: NotStopd t0: [12:21:00 03/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 118 u1: mmHg rs: Final st: NotStopd t0: [12:21:00 03/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.39 rs: Final st: NotStopd t0: [12:21:00 03/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.14 rs: Final st: NotStopd
t0: [12:19:00 03/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 35.5 u1: % rs: Final st: NotStopd
t0: [12:19:00 03/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.2 rs: Final st: NotStopd t0: [12:19:00 03/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [12:19:00 03/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 71.3 rs: Final st: NotStopd t0: [12:19:00 03/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [12:19:00 03/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.2 rs: Final st: NotStopd t0: [12:19:00 03/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 71.3 rs: Final st: NotStopd
t0: [13:00:00 03/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd
t0: [13:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [13:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [13:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 143 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [13:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [13:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [13:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 43 u1: BPM st: NotStopd t0: [13:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [13:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [13:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [13:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [13:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:00:00 03/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [11:00:00 03/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [12:00:00 03/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [13:00:00 03/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml
t0: [14:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [14:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [14:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 150 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [14:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [14:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [14:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [14:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [14:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [14:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [14:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:49:00 03/01/2016] id: Albumin Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.1 rs: Final st: NotStopd t0: [02:49:00 03/01/2016] id: Albumin (>3.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.1 rs: Final st: NotStopd
t0: [15:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [15:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [15:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 177 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [15:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [15:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [15:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [15:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [15:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [15:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [15:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 03/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [15:00:00 03/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 03/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [15:00:00 03/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 03/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [15:00:00 03/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 03/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 03/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 03/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [16:00:00 03/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 03/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 03/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 03/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 03/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [16:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 03/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: RN v1: Right Anterior st: NotStopd t0: [16:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Agitated st: NotStopd t0: [16:00:00 03/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 03/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 03/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 03/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 03/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 03/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 03/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 03/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 03/01/2016] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 03/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 03/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 03/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 03/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 03/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 03/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 03/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [16:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 03/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [16:00:00 03/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [16:00:00 03/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 03/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 03/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [16:00:00 03/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 03/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [16:00:00 03/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [16:00:00 03/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 03/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 03/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Pink st: NotStopd t0: [16:00:00 03/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 03/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 03/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [16:00:00 03/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 03/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 03/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 03/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 03/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 03/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 03/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 03/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [16:00:00 03/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [16:00:00 03/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 03/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 03/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 170 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [16:00:00 03/01/2016] id: Pain Location el: 0 cu: CSRU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [16:00:00 03/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [16:00:00 03/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 03/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [16:00:00 03/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [16:00:00 03/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 03/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 03/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: White v2: Thick st: NotStopd t0: [16:00:00 03/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 03/01/2016] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Brown v2: Soft st: NotStopd t0: [16:00:00 03/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 03/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 03/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [16:00:00 03/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [16:00:00 03/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 03/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 03/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 03/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [16:00:00 03/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [16:00:00 03/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 03/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 03/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 03/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [16:00:00 03/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [16:00:00 03/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 03/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [16:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [16:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [16:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [16:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:13:00 03/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [16:13:00 03/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 90 rs: Final st: NotStopd t0: [16:13:00 03/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 7 rs: Final st: NotStopd t0: [16:13:00 03/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 33 rs: Final st: NotStopd t0: [16:13:00 03/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 48 u1: mmHg rs: Final st: NotStopd t0: [16:13:00 03/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 129 u1: mmHg rs: Final st: NotStopd t0: [16:13:00 03/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [16:13:00 03/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 90 rs: Final st: NotStopd t0: [16:13:00 03/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.14 rs: Final st: NotStopd
t0: [16:13:00 03/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 3.8 rs: Final st: NotStopd t0: [16:13:00 03/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 3.8 rs: Final st: NotStopd
t0: [16:00:00 03/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.1935 u1: ml/cmH st: NotStopd t0: [16:00:00 03/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 20 t0: [16:00:00 03/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:00:00 03/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 03/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [16:00:00 03/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [16:00:00 03/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3.2 st: NotStopd t0: [16:00:00 03/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:00:00 03/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [16:00:00 03/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [16:00:00 03/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 03/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 03/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 03/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 03/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [16:00:00 03/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.5 u1: L/min st: NotStopd t0: [16:00:00 03/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 03/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 03/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [16:00:00 03/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [16:00:00 03/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [16:00:00 03/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [16:00:00 03/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [16:00:00 03/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [16:00:00 03/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [16:00:00 03/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [16:00:00 03/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [16:00:00 03/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [16:00:00 03/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 183 u1: ml/B st: NotStopd t0: [16:00:00 03/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [16:00:00 03/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 03/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [17:00:00 03/01/2016] id: ETT Position Change el: 0 cu: CSRU cg: RRT v1: Done st: NotStopd
t0: [17:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [17:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [17:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 165 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [17:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [17:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [17:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [17:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 03/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [17:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [17:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [17:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [17:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:00:00 02/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [18:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [18:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 172 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [18:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 117 u1: mmHg st: NotStopd t0: [18:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [18:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [18:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 03/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [18:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [18:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [18:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [18:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:00:00 03/01/2016] id: CT #3 Crepitus el: 0 cu: CSRU cg: -1 st: D/C'd t0: [18:00:00 03/01/2016] id: CT #3 Drainage el: 0 cu: CSRU cg: -1 st: D/C'd t0: [18:00:00 03/01/2016] id: CT #3 Dressing el: 0 cu: CSRU cg: -1 st: D/C'd t0: [18:00:00 03/01/2016] id: CT #3 Fluctuate/Leak el: 0 cu: CSRU cg: -1 st: D/C'd t0: [18:00:00 03/01/2016] id: CT #3 Suction Amount el: 0 cu: CSRU cg: -1 st: D/C'd t0: [18:00:00 03/01/2016] id: Chest Tube Site #3 el: 0 cu: CSRU cg: -1 st: D/C'd
tf: [11:00:00 07/01/2016] pt: IV Piggyback rt: IV fr: Q8H fs: 2, 10, 18 dn: 3 m1: Piperacillin-Tazobactam Na v1: 4.5 u1: gm m2: Iso-Osmotic Dextrose v2: 100 u2: ml tf: [08:00:00 08/01/2016] pt: Unit Dose rt: IV fr: Q4H:PRN m1: Hydralazine HCl v1: 10 u1: mg
t0: [19:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [19:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [19:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 149 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [19:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [19:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [19:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [19:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [19:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [19:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [19:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 03/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 16.9231 u1: ml/cmH st: NotStopd t0: [20:00:00 03/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 20 t0: [20:00:00 03/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 03/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 03/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 03/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [20:00:00 03/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.8 st: NotStopd t0: [20:00:00 03/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 03/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 03/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [20:00:00 03/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 03/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 03/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 03/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 03/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 03/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.3 u1: L/min st: NotStopd t0: [20:00:00 03/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 03/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 03/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [20:00:00 03/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [20:00:00 03/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:00:00 03/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [20:00:00 03/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 23 u1: BPM st: NotStopd t0: [20:00:00 03/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [20:00:00 03/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [20:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:00:00 03/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [20:00:00 03/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 03/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 03/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 03/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 132 u1: ml/B st: NotStopd t0: [20:00:00 03/01/2016] id: Total PEEP Level el: 0 cu: CSRU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [20:00:00 03/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [20:00:00 03/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 03/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [20:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [20:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 164 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [20:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [20:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [20:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 15 u1: BPM st: NotStopd t0: [20:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 03/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [21:00:00 03/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [21:00:00 03/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [21:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 03/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 03/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [21:00:00 03/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [21:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 03/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [21:00:00 03/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [21:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 03/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [21:00:00 03/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 03/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [21:00:00 03/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [21:00:00 03/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [21:00:00 03/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [21:00:00 03/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [21:00:00 03/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [21:00:00 03/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [21:00:00 03/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [21:00:00 03/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [21:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [21:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 03/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [21:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [21:00:00 03/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 03/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [21:00:00 03/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Pink st: NotStopd t0: [21:00:00 03/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [21:00:00 03/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [21:00:00 03/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [21:00:00 03/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 03/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 03/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 03/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [21:00:00 03/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [21:00:00 03/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [21:00:00 03/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 03/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 03/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [21:00:00 03/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 03/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [21:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 161 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [21:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [21:00:00 03/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [21:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [21:00:00 03/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 03/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [21:00:00 03/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [21:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [21:00:00 03/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 03/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [21:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 03/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [21:00:00 03/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [21:00:00 03/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [21:00:00 03/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [21:00:00 03/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [21:00:00 03/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 03/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 03/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [21:00:00 03/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [21:00:00 03/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [21:00:00 03/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [21:00:00 03/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [21:00:00 03/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [21:00:00 03/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 14 u1: number st: NotStopd t0: [21:00:00 03/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [21:00:00 03/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [20:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [20:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [20:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [21:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [21:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [21:00:00 03/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml t0: [21:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [20:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip t0: [21:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 64 u1: BPM st: NotStopd t0: [22:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [22:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 130 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [22:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [22:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [22:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 42 u1: BPM st: NotStopd t0: [22:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [22:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [22:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [22:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:33:00 03/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.48 rs: Final st: NotStopd t0: [22:33:00 03/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.3 rs: Final st: NotStopd t0: [22:33:00 03/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: no data rs: Final st: NotStopd t0: [22:33:00 03/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: no data rs: Final st: NotStopd t0: [22:33:00 03/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 u1: mmHg rs: Final st: NotStopd t0: [22:33:00 03/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 u1: mmHg rs: Final st: NotStopd t0: [22:33:00 03/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.48 rs: Final st: NotStopd t0: [22:33:00 03/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.04 rs: Final st: NotStopd t0: [22:33:00 03/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.3 rs: Final st: NotStopd
t0: [23:00:00 03/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 03/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 03/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 03/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 03/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 03/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [23:00:00 03/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 03/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [23:00:00 03/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 146 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [23:00:00 03/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [23:00:00 03/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 03/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 63.2 u1: kg st: NotStopd t0: [23:00:00 03/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [23:00:00 03/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 03/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 03/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [23:00:00 03/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 03/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [23:00:00 03/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [23:00:00 03/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [23:00:00 03/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [00:00:00 04/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.7143 u1: ml/cmH st: NotStopd t0: [00:00:00 04/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 20 t0: [00:00:00 04/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 04/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 04/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 04/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [00:00:00 04/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.8 st: NotStopd t0: [00:00:00 04/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 04/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 04/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [00:00:00 04/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 04/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 04/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 04/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 04/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [00:00:00 04/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [00:00:00 04/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 04/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 04/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [00:00:00 04/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [00:00:00 04/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [00:00:00 04/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [00:00:00 04/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [00:00:00 04/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [00:00:00 04/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [00:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:00:00 04/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White v2: Thick st: NotStopd t0: [00:00:00 04/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [00:00:00 04/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [00:00:00 04/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [00:00:00 04/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 178 u1: ml/B st: NotStopd t0: [00:00:00 04/01/2016] id: Total PEEP Level el: 0 cu: CSRU cg: RRT v1: 6.3 u1: cmH2O st: NotStopd t0: [00:00:00 04/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [00:00:00 04/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 04/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [23:00:00 03/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [23:00:00 03/01/2016] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [23:00:00 03/01/2016] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [23:00:00 03/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [23:00:00 03/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [23:00:00 03/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [23:00:00 03/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [00:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [00:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [00:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 139 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [00:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [00:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [00:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [00:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [00:00:00 04/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml t0: [00:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [00:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 04/01/2016] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 290 ap: none
t0: [01:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 04/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [01:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [01:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 129 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [01:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [01:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [01:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [01:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [01:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [01:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [01:00:00 04/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [01:00:00 04/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [01:00:00 04/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [01:00:00 04/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [01:00:00 04/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [01:00:00 04/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [01:00:00 04/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [01:00:00 04/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [02:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [02:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 118 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [02:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [02:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 37 u1: BPM st: NotStopd t0: [02:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [02:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 04/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [03:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 04/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [03:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 04/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [03:00:00 04/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [03:00:00 04/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [03:00:00 04/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [03:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 64 u1: BPM st: NotStopd t0: [03:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 04/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [03:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 109 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [03:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [03:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 04/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [03:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [03:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 04/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [03:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 04/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [02:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [02:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [02:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [03:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [03:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [03:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [02:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip t0: [03:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 04/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 140 cv: 140 ap: none t0: [23:00:00 04/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -72.6 cv: -72.6 ap: none t0: [23:00:00 04/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 17 cv: 1408 ap: none t0: [23:00:00 04/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 67.4 cv: 2980.4 ap: none t0: [23:00:00 04/01/2016] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 40 cv: 960 ap: none t0: [23:00:00 04/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 140 cv: 4660 ap: none t0: [23:00:00 04/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -72.6 cv: -1679.6 ap: none t0: [23:00:00 04/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 140 cv: 4660 ap: none t0: [23:00:00 04/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -72.6 cv: 834.745 ap: carryForward
t0: [01:00:00 04/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 68.2 u1: kg st: NotStopd t0: [02:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [02:00:00 04/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 68.2 u1: kg st: NotStopd t0: [03:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [03:00:00 04/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 68.2 u1: kg st: NotStopd
t0: [02:56:00 04/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.47 rs: Final st: NotStopd t0: [02:56:00 04/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [02:56:00 04/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 12 rs: Final st: NotStopd t0: [02:56:00 04/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 38 rs: Final st: NotStopd t0: [02:56:00 04/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 51 u1: mmHg rs: Final st: NotStopd t0: [02:56:00 04/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 135 u1: mmHg rs: Final st: NotStopd t0: [02:56:00 04/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.47 rs: Final st: NotStopd t0: [02:56:00 04/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.21 rs: Final st: NotStopd t0: [02:56:00 04/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd
t0: [02:36:00 04/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 16.4 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 16.4 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 33 u1: % rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.2 u1: gm/dl rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 554 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.59 u1: /mic l rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 16.4 rs: Final st: NotStopd
t0: [02:36:00 04/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.4 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 69.7 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.4 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 69.7 rs: Final st: NotStopd
t0: [02:36:00 04/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 29 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 9.3 u1: mg/dl rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 101 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 111 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.7 u1: mEq/L rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 140 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 29 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 9.3 u1: mg/dl rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 32 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 101 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.1 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 111 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.7 u1: mEq/L rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 140 rs: Final st: NotStopd
t0: [20:00:00 03/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 03/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [20:00:00 03/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 03/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 03/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 03/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 03/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 03/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 03/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 03/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 03/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 03/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 03/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [20:00:00 03/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [20:00:00 03/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 03/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [21:00:00 03/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [23:00:00 03/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [23:00:00 03/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [23:00:00 03/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [23:00:00 03/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 04/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 04/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [00:00:00 04/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [00:00:00 04/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 04/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 04/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [00:00:00 04/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 04/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 04/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 04/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 04/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 04/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 04/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 04/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [00:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [00:00:00 04/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 04/01/2016] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.06643 u1: m2 st: NotStopd t0: [00:00:00 04/01/2016] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.24867 u1: m2 st: NotStopd t0: [00:00:00 04/01/2016] id: Weight Change el: 0 cu: CSRU cg: RN v1: 0 u1: kg st: NotStopd t0: [00:00:00 04/01/2016] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [01:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [02:00:00 04/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [02:00:00 04/01/2016] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [02:00:00 04/01/2016] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [02:00:00 04/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [02:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [02:00:00 04/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thin st: NotStopd t0: [02:00:00 04/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [02:00:00 04/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [02:36:00 04/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 4.2 rs: Final st: NotStopd t0: [02:36:00 04/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 4.2 rs: Final st: NotStopd t0: [03:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [04:00:00 04/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 04/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 04/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 04/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 04/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 04/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 04/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 04/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 04/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 04/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 04/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 04/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 04/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 04/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 04/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 04/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 04/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [04:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 04/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [04:00:00 04/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [04:00:00 04/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 04/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 04/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [04:00:00 04/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 04/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [04:00:00 04/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [04:00:00 04/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 04/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 04/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 04/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 04/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Pink st: NotStopd t0: [04:00:00 04/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 04/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 04/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [04:00:00 04/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 04/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 04/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 04/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 04/01/2016] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [04:00:00 04/01/2016] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [04:00:00 04/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 04/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 04/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [04:00:00 04/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 04/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 04/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [04:00:00 04/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 04/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 04/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [04:00:00 04/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 131 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [04:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [04:00:00 04/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 04/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 04/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 04/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 62.8 u1: kg st: NotStopd t0: [04:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [04:00:00 04/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [04:00:00 04/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [04:00:00 04/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [04:00:00 04/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 04/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 04/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [04:00:00 04/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [04:00:00 04/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 04/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [04:00:00 04/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [04:00:00 04/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [04:00:00 04/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 04/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [04:00:00 04/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 04/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [04:00:00 04/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 04/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [04:00:00 04/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 04/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 04/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 04/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [04:00:00 04/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 04/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [04:00:00 04/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 04/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [04:00:00 04/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [04:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [04:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [04:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [04:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:00:00 04/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.6667 u1: ml/cmH st: NotStopd t0: [04:00:00 04/01/2016] id: RSBI (<100) el: 0 cu: CSRU cg: RRT v1: 185.185 u1: units st: NotStopd t0: [04:00:00 04/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 20 t0: [04:00:00 04/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 04/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 04/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [04:00:00 04/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.8 st: NotStopd t0: [04:00:00 04/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 04/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 04/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 04/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 04/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [04:00:00 04/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [04:00:00 04/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 04/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 04/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [04:00:00 04/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [04:00:00 04/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [04:00:00 04/01/2016] id: RSBI (<200) el: 0 cu: CSRU cg: RRT v1: 185.185 u1: units st: NotStopd t0: [04:00:00 04/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [04:00:00 04/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 21 u1: BPM st: NotStopd t0: [04:00:00 04/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [04:00:00 04/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [04:00:00 04/01/2016] id: Spon RR (Mech.) el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:00:00 04/01/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: CSRU cg: RRT v1: 0.189 u1: L st: NotStopd t0: [04:00:00 04/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [04:00:00 04/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [04:00:00 04/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 169 u1: ml/B st: NotStopd t0: [04:00:00 04/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [04:00:00 04/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [05:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [05:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [05:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 128 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [05:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [05:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [05:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [05:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [05:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [05:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [05:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [05:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [06:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [06:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.5 t0: [06:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 138 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [06:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [06:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [06:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [06:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [06:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 20.8 vu: ml t0: [06:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [06:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [07:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [07:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [07:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 122 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [07:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [07:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [07:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [07:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [07:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [07:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [07:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 04/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.7143 u1: ml/cmH st: NotStopd t0: [08:00:00 04/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 20 t0: [08:00:00 04/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 04/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 04/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:00:00 04/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [08:00:00 04/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.8 st: NotStopd t0: [08:00:00 04/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 04/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 04/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 04/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 04/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 04/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 04/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 04/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [08:00:00 04/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [08:00:00 04/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 04/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 04/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [08:00:00 04/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [08:00:00 04/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 15 u1: . st: NotStopd t0: [08:00:00 04/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [08:00:00 04/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [08:00:00 04/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [08:00:00 04/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [08:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 04/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 430 u1: ml/B st: NotStopd t0: [08:00:00 04/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [08:00:00 04/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [08:00:00 04/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [08:00:00 04/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 04/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 04/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 04/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 04/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 04/01/2016] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 04/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 04/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 04/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 04/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 04/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 04/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 04/01/2016] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Anxiety st: NotStopd t0: [08:00:00 04/01/2016] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [08:00:00 04/01/2016] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [08:00:00 04/01/2016] id: Education Readiness el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/01/2016] id: Education Response el: 0 cu: CSRU cg: RN v1: Understands st: NotStopd t0: [08:00:00 04/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [08:00:00 04/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 04/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 04/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 04/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 04/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 04/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 04/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 04/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 04/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 04/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [08:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 04/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 04/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [08:00:00 04/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 04/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 04/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 04/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 04/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 04/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [08:00:00 04/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [08:00:00 04/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 04/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 04/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 04/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 04/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 04/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 04/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 04/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 04/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 04/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 04/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 04/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 04/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [08:00:00 04/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 04/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 04/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:00:00 04/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 124 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [08:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [08:00:00 04/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [08:00:00 04/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 04/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [08:00:00 04/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 04/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 04/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [08:00:00 04/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 04/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 04/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [08:00:00 04/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [08:00:00 04/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 04/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 04/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [08:00:00 04/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [08:00:00 04/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [08:00:00 04/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [08:00:00 04/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 04/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 04/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 04/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [08:00:00 04/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 04/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 04/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 04/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 04/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [08:00:00 04/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 04/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [09:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [09:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [09:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [09:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 126 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [09:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [09:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [09:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 48 u1: BPM st: NotStopd t0: [09:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [08:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [08:00:00 04/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml t0: [08:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [09:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [09:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [08:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip t0: [09:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [08:00:00 05/01/2016] pt: IV Piggyback rt: IV fr: INFUSION m1: Bumetanide v1: 12 u1: mg m2: D5W v2: 500 u2: ml tf: [13:00:00 06/01/2016] pt: Unit Dose rt: PO fr: HS:PRN m1: Zolpidem Tartrate v1: 5 u1: mg
t0: [09:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml
t0: [09:00:00 04/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd
t0: [10:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [10:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 63 u1: BPM st: NotStopd t0: [10:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [10:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 115 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [10:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [10:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [10:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [10:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [10:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [10:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [10:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:40:00 04/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: RN v1: 7.51 rs: Manual st: NotStopd t0: [09:40:00 04/01/2016] id: CaO2 el: 0 cu: CSRU cg: RN v1: 13.8286 u1: ml/dl st: NotStopd t0: [09:40:00 04/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 3.6 rs: Manual st: NotStopd t0: [09:40:00 04/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: RN v1: 45 u1: mmHg rs: Manual st: NotStopd t0: [09:40:00 04/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: RN v1: 140 u1: mmHg rs: Manual st: NotStopd t0: [09:40:00 04/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: RN v1: 7.51 rs: Manual st: NotStopd t0: [09:40:00 04/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: RN v1: 1.12 rs: Manual st: NotStopd t0: [09:40:00 04/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 3.6 rs: Manual st: NotStopd t0: [09:40:00 04/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: RN v1: 98 u1: % rs: Manual st: NotStopd t0: [11:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [11:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 63 u1: BPM st: NotStopd t0: [11:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [11:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [11:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [11:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [11:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 10 u1: BPM st: NotStopd t0: [11:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 04/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [11:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [11:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [11:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [11:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:00:00 04/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [10:00:00 04/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd
t0: [12:00:00 04/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 04/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [12:00:00 04/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [12:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [12:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 04/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 04/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 04/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 04/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 04/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 04/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 04/01/2016] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Anxiety st: NotStopd t0: [12:00:00 04/01/2016] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [12:00:00 04/01/2016] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [12:00:00 04/01/2016] id: Education Readiness el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 04/01/2016] id: Education Response el: 0 cu: CSRU cg: RN v1: Understands st: NotStopd t0: [12:00:00 04/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [12:00:00 04/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 04/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 04/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 04/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 04/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 04/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Not Done st: NotStopd t0: [12:00:00 04/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 04/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 04/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [12:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 04/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [12:00:00 04/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [12:00:00 04/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 04/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [12:00:00 04/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [12:00:00 04/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 04/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [12:00:00 04/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [12:00:00 04/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [12:00:00 04/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [12:00:00 04/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 04/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 04/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 04/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 04/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [12:00:00 04/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [12:00:00 04/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 04/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 04/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [12:00:00 04/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 04/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 04/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [12:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 132 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [12:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [12:00:00 04/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 04/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [12:00:00 04/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [12:00:00 04/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 04/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 04/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [12:00:00 04/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [12:00:00 04/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 04/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 04/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.3889 u1: Deg. C st: NotStopd t0: [12:00:00 04/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.5 u1: Deg. F st: NotStopd t0: [12:00:00 04/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [12:00:00 04/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 04/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 04/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 100 rs: Manual st: NotStopd t0: [12:00:00 04/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [12:00:00 04/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [12:00:00 04/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [12:00:00 04/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [12:00:00 04/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [12:00:00 04/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [12:00:00 04/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [12:00:00 04/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: No Impairment st: NotStopd t0: [12:00:00 04/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [12:00:00 04/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [12:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [12:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [12:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [12:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 04/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.7143 u1: ml/cmH st: NotStopd t0: [12:00:00 04/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 20 t0: [12:00:00 04/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 04/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 04/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [12:00:00 04/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:00:00 04/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.8 st: NotStopd t0: [12:00:00 04/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 04/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 04/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 04/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 04/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 04/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 04/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 04/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:00:00 04/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.4 u1: L/min st: NotStopd t0: [12:00:00 04/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 04/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 04/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [12:00:00 04/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [12:00:00 04/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [12:00:00 04/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [12:00:00 04/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [12:00:00 04/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [12:00:00 04/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 430 u1: ml/B st: NotStopd t0: [12:00:00 04/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [12:00:00 04/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 170 u1: ml/B st: NotStopd t0: [12:00:00 04/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [12:00:00 04/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 04/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [13:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [13:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 04/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [13:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 141 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [13:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [13:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [13:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 36 u1: BPM st: NotStopd t0: [13:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [13:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [13:00:00 04/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml t0: [13:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [13:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [14:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 04/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [14:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [14:00:00 04/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 04/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [14:00:00 04/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 164 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [14:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [14:00:00 04/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 04/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [14:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 40 u1: BPM st: NotStopd t0: [14:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 04/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:15:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [14:15:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:15:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:15:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:15:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:15:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [14:15:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:15:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [14:15:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 192 u1: mmHg v2: 95 u2: mmHg st: NotStopd t0: [14:15:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 127 u1: mmHg st: NotStopd t0: [14:15:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:15:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [14:15:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [14:15:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [14:15:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [14:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [14:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [14:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip t0: [14:15:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [14:00:00 04/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: None st: NotStopd
t0: [12:00:00 04/01/2016] id: PTT Coags el: 0 cu: CSRU cg: RN v1: 57.8 rs: Manual st: NotStopd t0: [12:00:00 04/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: RN v1: 57.8 rs: Manual st: NotStopd t0: [15:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [15:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [15:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [15:00:00 04/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [15:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 143 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [15:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [15:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [15:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 42 u1: BPM st: NotStopd t0: [15:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [15:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [15:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [15:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [12:00:00 04/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [15:00:00 04/01/2016] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [15:00:00 04/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Relative st: NotStopd t0: [16:00:00 04/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 04/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [16:00:00 04/01/2016] id: shampoo el: 0 cu: CSRU cg: RN v1: done t0: [16:00:00 04/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [16:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [16:00:00 04/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: RN v1: 7.46 rs: Manual st: NotStopd t0: [16:00:00 04/01/2016] id: CaO2 el: 0 cu: CSRU cg: RN v1: 13.7945 u1: ml/dl st: NotStopd t0: [16:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 04/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 04/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 04/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 04/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 3.8 rs: Manual st: NotStopd t0: [16:00:00 04/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 04/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 04/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 04/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 04/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 04/01/2016] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Anxiety st: NotStopd t0: [16:00:00 04/01/2016] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [16:00:00 04/01/2016] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [16:00:00 04/01/2016] id: Education Readiness el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 04/01/2016] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [16:00:00 04/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [16:00:00 04/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 04/01/2016] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 04/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 04/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 04/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 04/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 04/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 04/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 04/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 04/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [16:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 04/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [16:00:00 04/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [16:00:00 04/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 04/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [16:00:00 04/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [16:00:00 04/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 04/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [16:00:00 04/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [16:00:00 04/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 04/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 04/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [16:00:00 04/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 04/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 04/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 04/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 04/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 04/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [16:00:00 04/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 04/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 04/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [16:00:00 04/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 04/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 04/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 04/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [16:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [16:00:00 04/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [16:00:00 04/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 04/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [16:00:00 04/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 48 u1: BPM st: NotStopd t0: [16:00:00 04/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 04/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 04/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [16:00:00 04/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [16:00:00 04/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 04/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 04/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [16:00:00 04/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [16:00:00 04/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [16:00:00 04/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [16:00:00 04/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 04/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 04/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: RN v1: 10 rs: Manual st: NotStopd t0: [16:00:00 04/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: RN v1: 37 rs: Manual st: NotStopd t0: [16:00:00 04/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: RN v1: 50 u1: mmHg rs: Manual st: NotStopd t0: [16:00:00 04/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: RN v1: 129 u1: mmHg rs: Manual st: NotStopd t0: [16:00:00 04/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: RN v1: 7.46 rs: Manual st: NotStopd t0: [16:00:00 04/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [16:00:00 04/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: RN v1: 1.19 rs: Manual st: NotStopd t0: [16:00:00 04/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 3.8 rs: Manual st: NotStopd t0: [16:00:00 04/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [16:00:00 04/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: RN v1: 98 u1: % rs: Manual st: NotStopd t0: [16:00:00 04/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 04/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 04/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 04/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 04/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [16:00:00 04/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: No Impairment st: NotStopd t0: [16:00:00 04/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [16:00:00 04/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [16:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [16:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [16:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [16:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:00:00 04/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 14.1935 u1: ml/cmH st: NotStopd t0: [17:00:00 04/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [17:00:00 04/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [17:00:00 04/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [17:00:00 04/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [17:00:00 04/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [17:00:00 04/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.8 st: NotStopd t0: [17:00:00 04/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 04/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 04/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 04/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 04/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [17:00:00 04/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 04/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:00:00 04/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [17:00:00 04/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9 u1: L/min st: NotStopd t0: [17:00:00 04/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 04/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 04/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [17:00:00 04/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [17:00:00 04/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [17:00:00 04/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [17:00:00 04/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [17:00:00 04/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [17:00:00 04/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [17:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [17:00:00 04/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 410 u1: ml/B st: NotStopd t0: [17:00:00 04/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [17:00:00 04/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 100 u1: ml/B st: NotStopd t0: [17:00:00 04/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [17:00:00 04/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 04/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [17:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [17:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [17:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [17:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 128 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [17:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [17:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [17:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [17:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [17:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [17:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [17:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:00:00 04/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [17:00:00 04/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [17:00:00 04/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [17:00:00 04/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [17:00:00 04/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd
t0: [18:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [18:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 155 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [18:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [18:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [18:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [18:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 04/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Tan v2: Thick st: NotStopd t0: [18:00:00 04/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [18:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [18:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [18:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [18:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:00:00 04/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [18:00:00 04/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 04/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 04/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 04/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [18:00:00 04/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 04/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd
t0: [18:20:00 04/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.49 rs: Final st: NotStopd t0: [18:20:00 04/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 120 rs: Final st: NotStopd t0: [18:20:00 04/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [18:20:00 04/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: no data rs: Final st: NotStopd t0: [18:20:00 04/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: no data rs: Final st: NotStopd t0: [18:20:00 04/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 u1: mmHg rs: Final st: NotStopd t0: [18:20:00 04/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 u1: mmHg rs: Final st: NotStopd t0: [18:20:00 04/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.49 rs: Final st: NotStopd t0: [18:20:00 04/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 120 rs: Final st: NotStopd t0: [18:20:00 04/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.21 rs: Final st: NotStopd t0: [18:20:00 04/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd
t0: [18:00:00 04/01/2016] id: ETT Position Change el: 0 cu: CSRU cg: RRT v1: Done st: NotStopd
t0: [18:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [19:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [19:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [19:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [19:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 135 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [19:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [19:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [19:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [19:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [19:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [19:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [19:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [09:39:00 04/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.51 rs: Final st: NotStopd t0: [09:39:00 04/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.8286 u1: ml/dl st: NotStopd t0: [09:39:00 04/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [09:39:00 04/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 11 rs: Final st: NotStopd t0: [09:39:00 04/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 37 rs: Final st: NotStopd t0: [09:39:00 04/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [09:39:00 04/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 140 u1: mmHg rs: Final st: NotStopd t0: [09:39:00 04/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.51 rs: Final st: NotStopd t0: [09:39:00 04/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.12 rs: Final st: NotStopd t0: [09:39:00 04/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [09:39:00 04/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [15:59:00 04/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.46 rs: Final st: NotStopd t0: [15:59:00 04/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.7945 u1: ml/dl st: NotStopd t0: [15:59:00 04/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [15:59:00 04/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 10 rs: Final st: NotStopd t0: [15:59:00 04/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 37 rs: Final st: NotStopd t0: [15:59:00 04/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 50 u1: mmHg rs: Final st: NotStopd t0: [15:59:00 04/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 129 u1: mmHg rs: Final st: NotStopd t0: [15:59:00 04/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.46 rs: Final st: NotStopd t0: [15:59:00 04/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.19 rs: Final st: NotStopd t0: [15:59:00 04/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [15:59:00 04/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [17:26:00 04/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [17:26:00 04/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd
t0: [17:23:00 04/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 57.8 rs: Final st: NotStopd t0: [17:23:00 04/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 57.8 rs: Final st: NotStopd
t0: [20:00:00 04/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.1724 u1: ml/cmH st: NotStopd t0: [20:00:00 04/01/2016] id: RSBI Not Completed el: 0 cu: CSRU cg: RRT v1: PEEP >10 st: NotStopd t0: [20:00:00 04/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [20:00:00 04/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 04/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 04/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 04/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:00:00 04/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.8 st: NotStopd t0: [20:00:00 04/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 04/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 04/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 04/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 04/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 04/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 04/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 04/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [20:00:00 04/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.7 u1: L/min st: NotStopd t0: [20:00:00 04/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 04/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 04/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [20:00:00 04/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [20:00:00 04/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [20:00:00 04/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [20:00:00 04/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [20:00:00 04/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [20:00:00 04/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [20:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [20:00:00 04/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 04/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [20:00:00 04/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 425 u1: ml/B st: NotStopd t0: [20:00:00 04/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [20:00:00 04/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 106 u1: ml/B st: NotStopd t0: [20:00:00 04/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [20:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [20:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 137 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [20:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [20:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [20:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [20:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [20:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [20:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [20:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [21:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [21:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 04/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [21:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 125 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [21:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [21:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [21:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [21:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 04/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [21:00:00 04/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [21:00:00 04/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [21:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [21:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [21:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [21:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [21:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25
t0: [21:00:00 04/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [21:00:00 04/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [21:00:00 04/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 04/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [21:00:00 04/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [21:00:00 04/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [21:00:00 04/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [21:00:00 04/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [21:00:00 04/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [21:00:00 04/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [21:00:00 04/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [21:00:00 04/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [21:00:00 04/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [21:00:00 04/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [21:00:00 04/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [21:00:00 04/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [21:00:00 04/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [21:00:00 04/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right Subclavian st: NotStopd t0: [21:00:00 04/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [21:00:00 04/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [21:00:00 04/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [21:00:00 04/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 04/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [21:00:00 04/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [21:00:00 04/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm st: NotStopd t0: [21:00:00 04/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 04/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [21:00:00 04/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 04/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 04/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [21:00:00 04/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [21:00:00 04/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [21:00:00 04/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [21:00:00 04/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [21:00:00 04/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [21:00:00 04/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [21:00:00 04/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 04/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [21:00:00 04/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Crackles st: NotStopd t0: [21:00:00 04/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Bronchial st: NotStopd t0: [21:00:00 04/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [21:00:00 04/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 04/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [21:00:00 04/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [21:00:00 04/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 04/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 04/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [21:00:00 04/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
tf: [08:00:00 04/01/2016] pt: Unit Dose rt: PO fr: HS fs: 22 dn: 1 m1: Zolpidem Tartrate v1: 5 u1: mg
t0: [22:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [22:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [22:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [22:59:00 04/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 95 rs: Final st: NotStopd t0: [22:59:00 04/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [22:59:00 04/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 95 rs: Final st: NotStopd t0: [22:59:00 04/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd
t0: [22:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [22:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [22:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [22:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 158 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [22:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [22:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 37 u1: BPM st: NotStopd t0: [22:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 04/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [22:00:00 04/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [22:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 04/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [23:00:00 04/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 04/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 04/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 04/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [23:00:00 04/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 04/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [23:00:00 04/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 135 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [23:00:00 04/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [23:00:00 04/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [23:00:00 04/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [23:00:00 04/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 04/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 04/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 04/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [23:00:00 04/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [23:00:00 04/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [22:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip t0: [23:00:00 04/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 04/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [20:00:00 04/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd t0: [00:00:00 05/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 16.9231 u1: ml/cmH st: NotStopd t0: [00:00:00 05/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [00:00:00 05/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 05/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 05/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 05/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [00:00:00 05/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.8 st: NotStopd t0: [00:00:00 05/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 05/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 05/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 05/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 05/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 05/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 05/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [00:00:00 05/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 7.6 u1: L/min st: NotStopd t0: [00:00:00 05/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 05/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 05/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [00:00:00 05/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [00:00:00 05/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [00:00:00 05/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [00:00:00 05/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [00:00:00 05/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [00:00:00 05/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [00:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 05/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 453 u1: ml/B st: NotStopd t0: [00:00:00 05/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [00:00:00 05/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 118 u1: ml/B st: NotStopd t0: [00:00:00 05/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [00:00:00 05/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [23:05:00 04/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml
t0: [21:00:00 04/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 04/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Cooperative st: NotStopd t0: [21:00:00 04/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [21:00:00 04/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [21:00:00 04/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [21:00:00 04/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [21:00:00 04/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [21:00:00 04/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 16 u1: number st: NotStopd t0: [21:00:00 04/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [00:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 05/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 05/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 05/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 05/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [00:00:00 05/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 05/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 05/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 05/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 05/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 05/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 62 u1: BPM st: NotStopd t0: [00:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 05/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [00:00:00 05/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN st: NotStopd t0: [00:00:00 05/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 05/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 05/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 05/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 05/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 05/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 05/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 05/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 05/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 109 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [00:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [00:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [00:00:00 05/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 13 u1: BPM st: NotStopd t0: [00:00:00 05/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 05/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 05/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 05/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 05/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd
t0: [00:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [00:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [00:00:00 05/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml t0: [00:30:00 05/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml
t0: [00:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [22:00:00 04/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 04/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 04/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [22:00:00 04/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 04/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 04/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [22:00:00 04/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 04/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [22:00:00 04/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd
io: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ra: 60 ru: ml/hr
id: Tube Feeding el: 1 cu: CSRU cg: RN io: Tube Feeding PO/Gastric du: ml rt: Gastric/Feeding Tube
t0: [20:00:00 04/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 04/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 05/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 05/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [01:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 61 u1: BPM st: NotStopd t0: [01:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 05/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [01:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [01:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [01:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [01:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [01:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [01:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [01:00:00 05/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 40 vu: ml
t0: [01:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [01:31:00 05/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: -1 ai: 109 vo: 0 st: D/C'd
t0: [01:30:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml t0: [01:30:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 6 vu: ml t0: [01:30:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [01:30:00 05/01/2016] id: Nepro Tube Feeding el: 1 cu: CSRU cg: RN ai: 109 vo: 20 vu: ml t0: [02:00:00 05/01/2016] tf: [12:45:00 07/01/2016] dt: 3525 id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 0 vu: ml t0: [02:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 30 vu: ml
t0: [02:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [02:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 64 u1: BPM st: NotStopd t0: [02:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 05/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [02:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 124 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [02:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [02:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [02:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 15 u1: BPM st: NotStopd t0: [02:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [02:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml t0: [02:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 6 vu: ml t0: [02:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml
t0: [02:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:40:00 05/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [02:40:00 05/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Copious st: NotStopd
t0: [03:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [03:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [03:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 05/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [03:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 136 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [03:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [03:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [03:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [03:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [03:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [03:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 05/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 280 cv: 280 ap: none t0: [23:00:00 05/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -204 cv: -204 ap: none t0: [23:00:00 05/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 16 cv: 1081 ap: none t0: [23:00:00 05/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 76 cv: 2817.8 ap: none t0: [23:00:00 05/01/2016] dt: 24 id: Stool Out Total el: 3 cu: CSRU cg: RN cv: 0 ap: carryForward t0: [23:00:00 05/01/2016] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 60 cv: 1390 ap: none t0: [23:00:00 05/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 280 cv: 4540 ap: none t0: [23:00:00 05/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -204 cv: -1722.2 ap: carryForward t0: [23:00:00 05/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 280 cv: 4540 ap: carryForward t0: [23:00:00 05/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -204 cv: -887.455 ap: carryForward
t0: [03:30:00 05/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [03:30:00 05/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [03:30:00 05/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [03:30:00 05/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:30:00 05/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:30:00 05/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [03:30:00 05/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:30:00 05/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:30:00 05/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [03:30:00 05/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [03:30:00 05/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [03:30:00 05/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [03:30:00 05/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:50:00 05/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:50:00 05/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [03:50:00 05/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [03:50:00 05/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [03:50:00 05/01/2016] id: Pain Location el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [03:50:00 05/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [04:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [04:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 05/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 05/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [04:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 05/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [04:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 143 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [04:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [04:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [04:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [04:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [04:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [04:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:30:00 05/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.52 rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 96 rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 12 rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 37 rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 117 u1: mmHg rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.52 rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 96 rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [04:00:00 05/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 15.7143 u1: ml/cmH st: NotStopd t0: [04:00:00 05/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [04:00:00 05/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 05/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 05/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 05/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:00:00 05/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.8 st: NotStopd t0: [04:00:00 05/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 05/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 05/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 05/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 05/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 05/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 05/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [04:00:00 05/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.1 u1: L/min st: NotStopd t0: [04:00:00 05/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 05/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 05/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [04:00:00 05/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [04:00:00 05/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [04:00:00 05/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 05/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [04:00:00 05/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [04:00:00 05/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [04:00:00 05/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 445 u1: ml/B st: NotStopd t0: [04:00:00 05/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [04:00:00 05/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 98 u1: ml/B st: NotStopd t0: [04:00:00 05/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [04:00:00 05/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 05/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [04:10:00 05/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.9 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 13.9 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 29.7 u1: % rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 9.2 u1: gm/dl rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 524 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.22 u1: /mic l rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.9 rs: Final st: NotStopd t0: [04:30:00 05/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 12.4441 u1: ml/dl st: NotStopd
t0: [04:10:00 05/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 27 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 9 u1: mg/dl rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 96 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 105 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 139 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 27 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 9 u1: mg/dl rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 36 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 96 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 105 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 139 rs: Final st: NotStopd
t0: [04:10:00 05/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.4 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 88.5 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.4 rs: Final st: NotStopd t0: [04:10:00 05/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 88.5 rs: Final st: NotStopd
t0: [04:00:00 05/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 05/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 05/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 05/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 05/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [04:00:00 05/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 05/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 05/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 05/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 05/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 05/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 05/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 05/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 05/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 05/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 05/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 05/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 05/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Changed st: NotStopd t0: [04:00:00 05/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 05/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 05/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 05/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 05/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [04:00:00 05/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Bronchial st: NotStopd t0: [04:00:00 05/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Bronchial st: NotStopd t0: [04:00:00 05/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 05/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 05/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 05/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 05/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 05/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [05:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 62 u1: BPM st: NotStopd t0: [05:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 05/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [05:00:00 05/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [05:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 123 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [05:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [05:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [05:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 10 u1: BPM st: NotStopd t0: [05:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [05:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [05:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [05:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1200 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [06:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [06:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 63 u1: BPM st: NotStopd t0: [06:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 05/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [06:00:00 05/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [06:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [06:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [06:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 05/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [06:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 12 vu: ml t0: [06:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [06:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [06:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [05:00:00 05/01/2016] id: Spon RR (Mech.) el: 0 cu: CSRU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [05:00:00 05/01/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: CSRU cg: RRT v1: 0.145 u1: L st: NotStopd
t0: [06:45:00 05/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [06:45:00 05/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [06:45:00 05/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [06:45:00 05/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [06:45:00 05/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [06:45:00 05/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:45:00 05/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [06:45:00 05/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [06:45:00 05/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd
t0: [06:30:00 05/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 80 vu: ml
tf: [15:00:00 05/01/2016] pt: IV Piggyback rt: IV fr: PRN m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [06:00:00 06/01/2016] pt: Unit Dose rt: NG fr: ONCE fs: 7 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq
t0: [07:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [07:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 05/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 62 u1: BPM st: NotStopd t0: [07:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 05/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [07:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 131 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [07:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [07:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [07:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [07:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 05/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 05/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: CSRU st: NotStopd t0: [08:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 05/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 05/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 05/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 05/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 05/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 05/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 05/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 05/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 05/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 05/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 05/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 05/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 05/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 05/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 05/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 05/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 05/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 05/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 05/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 58 u1: BPM st: NotStopd t0: [08:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 05/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [08:00:00 05/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 05/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 05/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [08:00:00 05/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 05/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 05/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 05/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 05/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 05/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 05/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 05/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 05/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 05/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 05/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [08:00:00 05/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 05/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 05/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:00:00 05/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [08:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 133 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [08:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [08:00:00 05/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [08:00:00 05/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 05/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 05/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [08:00:00 05/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 05/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 05/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [08:00:00 05/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 05/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 05/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 05/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 05/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.9444 u1: Deg. C st: NotStopd t0: [08:00:00 05/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.7 u1: Deg. F st: NotStopd t0: [08:00:00 05/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 05/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 05/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 05/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 05/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [08:00:00 05/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [08:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 20 vu: ml t0: [08:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [08:00:00 05/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 90 vu: ml t0: [08:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 120 vu: ml
t0: [07:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [08:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 05/01/2016] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 170 ap: none
t0: [09:45:00 05/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RT v1: 14.1935 u1: ml/cmH st: NotStopd t0: [09:45:00 05/01/2016] id: high min. vol el: 0 cu: CSRU cg: RT v1: 17 t0: [09:45:00 05/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RT v1: 23cm v2: Lip st: NotStopd t0: [09:45:00 05/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RT v1: 0.3 u1: torr st: NotStopd t0: [09:45:00 05/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RT v1: 50 u1: cmH2O st: NotStopd t0: [09:45:00 05/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RT v1: 45 u1: BPM st: NotStopd t0: [09:45:00 05/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RT v1: 1:2.8 st: NotStopd t0: [09:45:00 05/01/2016] id: Airway Size el: 0 cu: CSRU cg: RT v1: 7.5 mm st: NotStopd t0: [09:45:00 05/01/2016] id: Airway Type el: 0 cu: CSRU cg: RT v1: Endotracheal st: NotStopd t0: [09:45:00 05/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RT v1: 33.8 u1: Deg. C st: NotStopd t0: [09:45:00 05/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RT v1: 12 v2: 23 st: NotStopd t0: [09:45:00 05/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RT v1: 5 st: NotStopd t0: [09:45:00 05/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RT v1: 6 v2: Albuterol st: NotStopd t0: [09:45:00 05/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RT v1: 6 v2: Atrovent st: NotStopd t0: [09:45:00 05/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RT v1: 13 u1: cmH2O st: NotStopd t0: [09:45:00 05/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RT v1: 9.2 u1: L/min st: NotStopd t0: [09:45:00 05/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RT v1: 5 u1: cmH2O st: NotStopd t0: [09:45:00 05/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RT v1: 20 st: NotStopd t0: [09:45:00 05/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RT v1: 36 u1: cmH2O st: NotStopd t0: [09:45:00 05/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RT v1: 31 u1: cmH2O st: NotStopd t0: [09:45:00 05/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RT v1: 5 u1: . st: NotStopd t0: [09:45:00 05/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RT v1: 21 u1: BPM st: NotStopd t0: [09:45:00 05/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RT v1: 37 u1: BPM st: NotStopd t0: [09:45:00 05/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RT v1: 16 u1: BPM st: NotStopd t0: [09:45:00 05/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RT v1: 4.5 u1: cmH2O st: NotStopd t0: [09:45:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RT v1: 100 u1: % st: NotStopd t0: [09:45:00 05/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RT v1: Yellow v2: Thick st: NotStopd t0: [09:45:00 05/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RT v1: Suctioned v2: Moderate st: NotStopd t0: [09:45:00 05/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RT v1: 450 u1: ml/B st: NotStopd t0: [09:45:00 05/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RT v1: 440 u1: ml/B st: NotStopd t0: [09:45:00 05/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RT v1: 130 u1: ml/B st: NotStopd t0: [09:45:00 05/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RT v1: SIMV+PS st: NotStopd t0: [09:45:00 05/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RT v1: Drager st: NotStopd t0: [09:45:00 05/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RT v1: RAMP st: NotStopd
tf: [08:00:00 08/01/2016] pt: Unit Dose rt: IV fr: BID fs: 10, 22 dn: 2 m1: Bumetanide v1: 2 u1: mg
t0: [09:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [09:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 05/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 61 u1: BPM st: NotStopd t0: [09:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 05/01/2016] id: bumex el: 0 cu: CSRU cg: RN v1: 0.25 t0: [09:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 149 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [09:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [09:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [09:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [09:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [10:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 05/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 63 u1: BPM st: NotStopd t0: [10:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 146 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [10:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [10:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [10:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [09:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [09:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml t0: [10:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [10:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [10:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [09:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [10:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [11:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 64 u1: BPM st: NotStopd t0: [11:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 132 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [11:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [11:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [11:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 17 u1: BPM st: NotStopd t0: [11:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [11:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [11:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [11:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 05/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [11:00:00 05/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [11:00:00 05/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [11:00:00 05/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 05/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [11:00:00 05/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [11:00:00 05/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [11:00:00 05/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd
t0: [12:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [12:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [12:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [11:00:00 05/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [11:00:00 05/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [11:00:00 05/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [11:00:00 05/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [12:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 05/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 05/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [12:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 152 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [12:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 160 u1: mmHg st: NotStopd t0: [12:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [12:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [12:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 05/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 05/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [12:00:00 05/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.4 u1: Deg. F st: NotStopd t0: [12:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [13:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [13:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 145 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [13:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [13:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 15 u1: BPM st: NotStopd t0: [13:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 05/01/2016] tf: [04:00:00 06/01/2016] dt: 900 id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 10 vu: ml t0: [13:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [13:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [13:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [12:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [13:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 05/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 117 rs: Final st: NotStopd t0: [12:00:00 05/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.8 rs: Final st: NotStopd t0: [12:00:00 05/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 117 rs: Final st: NotStopd t0: [12:00:00 05/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.8 rs: Final st: NotStopd
t0: [13:00:00 05/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 16.2963 u1: ml/cmH st: NotStopd t0: [13:00:00 05/01/2016] id: RSBI (<100) el: 0 cu: CSRU cg: RRT u1: units st: NotStopd t0: [13:00:00 05/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [13:00:00 05/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [13:00:00 05/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [13:00:00 05/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [13:00:00 05/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [13:00:00 05/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:2.8 st: NotStopd t0: [13:00:00 05/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:00:00 05/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [13:00:00 05/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.9 u1: Deg. C st: NotStopd t0: [13:00:00 05/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [13:00:00 05/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [13:00:00 05/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [13:00:00 05/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT st: NotStopd t0: [13:00:00 05/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [13:00:00 05/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [13:00:00 05/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:00:00 05/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [13:00:00 05/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [13:00:00 05/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [13:00:00 05/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 5 u1: . st: NotStopd t0: [13:00:00 05/01/2016] id: RSBI (<200) el: 0 cu: CSRU cg: RRT u1: units st: NotStopd t0: [13:00:00 05/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [13:00:00 05/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [13:00:00 05/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [13:00:00 05/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4.5 u1: cmH2O st: NotStopd t0: [13:00:00 05/01/2016] id: Spon RR (Mech.) el: 0 cu: CSRU cg: RRT v1: 58 u1: BPM st: NotStopd t0: [13:00:00 05/01/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: CSRU cg: RRT v1: 0.115 u1: L st: NotStopd t0: [13:00:00 05/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [13:00:00 05/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned st: NotStopd t0: [13:00:00 05/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 447 u1: ml/B st: NotStopd t0: [13:00:00 05/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 440 u1: ml/B st: NotStopd t0: [13:00:00 05/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 150 u1: ml/B st: NotStopd t0: [13:00:00 05/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: SIMV+PS st: NotStopd t0: [13:00:00 05/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [13:00:00 05/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [14:00:00 05/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RT v1: Yellow v2: Thick st: NotStopd t0: [14:00:00 05/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RT v1: Suctioned v2: Small st: NotStopd
t0: [10:00:00 05/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [11:00:00 05/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [11:00:00 05/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [11:00:00 05/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [11:00:00 05/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [11:00:00 05/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [11:00:00 05/01/2016] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden v2: Loose st: NotStopd t0: [11:00:00 05/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [11:00:00 05/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [12:00:00 05/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [14:00:00 05/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [14:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 05/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [14:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 05/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 05/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 05/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [14:00:00 05/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [14:00:00 05/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 05/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 05/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [14:00:00 05/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [14:00:00 05/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 05/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [14:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [14:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 05/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft st: NotStopd t0: [14:00:00 05/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 05/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 05/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 05/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 05/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [14:00:00 05/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 05/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 05/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [14:00:00 05/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 144 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [14:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [14:00:00 05/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 05/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [14:00:00 05/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 05/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 05/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [14:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 11 u1: BPM st: NotStopd t0: [14:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 05/01/2016] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden v2: Loose st: NotStopd t0: [14:00:00 05/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 05/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 05/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 05/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [14:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 05/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [14:00:00 05/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [14:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 05/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 50.5 rs: Final st: NotStopd t0: [12:00:00 05/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 50.5 rs: Final st: NotStopd
t0: [15:00:00 05/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RT v1: 0.3 u1: torr st: NotStopd t0: [15:00:00 05/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RT v1: 10 u1: cmH2O st: NotStopd t0: [15:00:00 05/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RT v1: 10.7 u1: L/min st: NotStopd t0: [15:00:00 05/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RT v1: 5 u1: cmH2O st: NotStopd t0: [15:00:00 05/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RT v1: 20 u1: . st: NotStopd t0: [15:00:00 05/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RT v1: 33 u1: BPM st: NotStopd t0: [15:00:00 05/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RT v1: 320 u1: ml/B st: NotStopd t0: [15:00:00 05/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RT v1: CPAP+PS st: NotStopd
t0: [16:00:00 05/01/2016] id: GI#1 Tube Stat/Drain el: 0 cu: CSRU cg: -1 st: D/C'd
tf: [16:00:00 06/01/2016] pt: Unit Dose rt: PO fr: PRN m1: Potassium Chloride v1: 40 u1: mEq tf: [13:00:00 07/01/2016] pt: IV Piggyback rt: IV fr: ASDIR m1: Heparin Sodium v1: 25000 u1: UNIT m2: D5W v2: 250 u2: ml tf: [10:00:00 02/02/2016] pt: Unit Dose rt: PR fr: QD:PRN m1: Bisacodyl (Rectal) v1: 10 u1: mg tf: [11:00:00 14/02/2016] pt: Unit Dose rt: TP fr: PRN m1: Benzocaine 20% Spray v1: 1 u1: SPRY
t0: [16:12:00 05/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.51 rs: Final st: NotStopd t0: [16:12:00 05/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 115 rs: Final st: NotStopd t0: [16:12:00 05/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 11 rs: Final st: NotStopd t0: [16:12:00 05/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 37 rs: Final st: NotStopd t0: [16:12:00 05/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [16:12:00 05/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 157 u1: mmHg rs: Final st: NotStopd t0: [16:12:00 05/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.51 rs: Final st: NotStopd t0: [16:12:00 05/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 115 rs: Final st: NotStopd
t0: [15:00:00 05/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [15:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 05/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [15:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [15:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [15:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [15:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [15:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 05/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [16:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 05/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 05/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 05/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 05/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 05/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 05/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 05/01/2016] id: GI Intub #1/Site el: 0 cu: CSRU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 05/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 05/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 05/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 05/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 05/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [16:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 05/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft st: NotStopd t0: [16:00:00 05/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 05/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 05/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [16:00:00 05/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 05/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 05/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 139 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [16:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [16:00:00 05/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [16:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 05/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 05/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 05/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 41 u1: BPM st: NotStopd t0: [16:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 05/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 05/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [16:00:00 05/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [16:00:00 05/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 05/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 05/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 05/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [16:00:00 05/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [14:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [14:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [14:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml t0: [15:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [15:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [15:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml t0: [16:00:00 05/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 10 vu: ml t0: [16:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [16:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [16:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [15:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [16:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [17:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [17:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 145 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [17:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [17:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [17:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [17:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [17:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [18:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 05/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [18:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 05/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [18:00:00 05/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [18:00:00 05/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [18:00:00 05/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [18:00:00 05/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [18:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 05/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 05/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 05/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [18:00:00 05/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [18:00:00 05/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [18:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 161 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [18:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [18:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 05/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 05/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 05/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [18:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 05/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [18:00:00 05/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [18:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [18:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [18:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [18:25:00 05/01/2016] id: high min. vol el: 0 cu: CSRU cg: RT v1: 17 t0: [18:25:00 05/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RT v1: 23cm v2: Lip st: NotStopd t0: [18:25:00 05/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RT v1: 0.3 u1: torr st: NotStopd t0: [18:25:00 05/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RT v1: 50 u1: cmH2O st: NotStopd t0: [18:25:00 05/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RT v1: 45 u1: BPM st: NotStopd t0: [18:25:00 05/01/2016] id: Airway Size el: 0 cu: CSRU cg: RT v1: 7.5 mm st: NotStopd t0: [18:25:00 05/01/2016] id: Airway Type el: 0 cu: CSRU cg: RT v1: Endotracheal st: NotStopd t0: [18:25:00 05/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RT v1: 33.7 u1: Deg. C st: NotStopd t0: [18:25:00 05/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RT v1: 12 v2: 23 st: NotStopd t0: [18:25:00 05/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RT v1: 5 st: NotStopd t0: [18:25:00 05/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RT v1: 6 v2: Albuterol st: NotStopd t0: [18:25:00 05/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RT v1: 6 v2: Atrovent st: NotStopd t0: [18:25:00 05/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RT v1: 10 u1: cmH2O st: NotStopd t0: [18:25:00 05/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RT v1: 11.7 u1: L/min st: NotStopd t0: [18:25:00 05/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RT v1: 5 u1: cmH2O st: NotStopd t0: [18:25:00 05/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RT v1: 20 st: NotStopd t0: [18:25:00 05/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RT v1: 18 u1: . st: NotStopd t0: [18:25:00 05/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RT v1: 34 u1: BPM st: NotStopd t0: [18:25:00 05/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RT v1: 4 u1: cmH2O st: NotStopd t0: [18:25:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RT v1: 100 u1: % st: NotStopd t0: [18:25:00 05/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RT v1: 350 u1: ml/B st: NotStopd t0: [18:25:00 05/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RT v1: CPAP+PS st: NotStopd t0: [18:25:00 05/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RT v1: Drager st: NotStopd
t0: [19:43:00 05/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.47 rs: Final st: NotStopd t0: [19:43:00 05/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [19:43:00 05/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 12 rs: Final st: NotStopd t0: [19:43:00 05/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 39 rs: Final st: NotStopd t0: [19:43:00 05/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 52 u1: mmHg rs: Final st: NotStopd t0: [19:43:00 05/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 140 u1: mmHg rs: Final st: NotStopd t0: [19:43:00 05/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.47 rs: Final st: NotStopd t0: [19:43:00 05/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [19:43:00 05/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd
t0: [19:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [19:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [19:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 162 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [19:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [19:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [19:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 46 u1: BPM st: NotStopd t0: [19:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 05/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 05/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [20:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [20:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 05/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 05/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 05/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 05/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 05/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 05/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 05/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 05/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 05/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 05/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 05/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 05/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 05/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 05/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 05/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [20:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 05/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 05/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 05/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [20:00:00 05/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 05/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 05/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 05/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 05/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft st: NotStopd t0: [20:00:00 05/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 05/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 05/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 05/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 05/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 05/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 05/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 05/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 05/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 05/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 05/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 05/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 05/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [20:00:00 05/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 05/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 05/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 05/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [20:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [20:00:00 05/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 05/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [20:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [20:00:00 05/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 05/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 05/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [20:00:00 05/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 05/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 05/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [20:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 05/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 05/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:00:00 05/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [20:00:00 05/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [20:00:00 05/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 05/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 05/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [20:00:00 05/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [20:00:00 05/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 05/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: No Limitations st: NotStopd t0: [20:00:00 05/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 05/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 05/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 18 u1: number st: NotStopd t0: [20:00:00 05/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: No Impairment st: NotStopd t0: [20:00:00 05/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [20:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 22 vu: ml t0: [20:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 120 vu: ml
t0: [19:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 05/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [20:00:00 05/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 05/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 05/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 05/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [20:00:00 05/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 05/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 05/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.7 u1: Deg. C st: NotStopd t0: [20:00:00 05/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 05/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 05/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 05/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 05/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:00:00 05/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.4 u1: L/min st: NotStopd t0: [20:00:00 05/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 05/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 05/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 18 u1: . st: NotStopd t0: [20:00:00 05/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:00:00 05/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [20:00:00 05/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 358 u1: ml/B st: NotStopd t0: [20:00:00 05/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 05/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [21:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [21:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 148 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [21:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [21:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [21:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [21:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [21:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [21:00:00 05/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: PCT v1: 126 rs: Manual st: NotStopd
t0: [22:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 05/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [22:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 146 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [22:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [22:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [22:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [22:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [22:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [22:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 05/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:00:00 05/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 05/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 05/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [23:00:00 05/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 05/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 162 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [23:00:00 05/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [23:00:00 05/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 61.9 u1: kg st: NotStopd t0: [23:00:00 05/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 20 u1: BPM st: NotStopd t0: [23:00:00 05/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 05/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 05/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 05/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [23:00:00 05/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [23:00:00 05/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 05/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [23:00:00 05/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 05/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [23:00:00 05/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [23:00:00 05/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [23:00:00 05/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [23:00:00 05/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [23:00:00 05/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [23:00:00 05/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd
t0: [00:00:00 06/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [00:00:00 06/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [00:00:00 06/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 06/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 06/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [00:00:00 06/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 06/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 06/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.9 u1: Deg. C st: NotStopd t0: [00:00:00 06/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 06/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 06/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 06/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 06/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 06/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.7 u1: L/min st: NotStopd t0: [00:00:00 06/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 06/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 06/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 18 u1: . st: NotStopd t0: [00:00:00 06/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [00:00:00 06/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [00:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 06/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 387 u1: ml/B st: NotStopd t0: [00:00:00 06/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 06/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [00:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [00:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 143 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [00:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [00:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 11 u1: BPM st: NotStopd t0: [00:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [00:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [00:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:17:00 05/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14 rs: Final st: NotStopd t0: [23:17:00 05/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [23:17:00 05/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 64.6 rs: Final st: NotStopd t0: [23:17:00 05/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [23:17:00 05/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14 rs: Final st: NotStopd t0: [23:17:00 05/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 64.6 rs: Final st: NotStopd
t0: [01:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [01:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 63 u1: BPM st: NotStopd t0: [01:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 110 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [01:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [01:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [01:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [01:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [01:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [01:01:00 06/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.58 rs: Final st: NotStopd t0: [01:01:00 06/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 13 rs: Final st: NotStopd t0: [01:01:00 06/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 37 rs: Final st: NotStopd t0: [01:01:00 06/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 38 u1: mmHg rs: Final st: NotStopd t0: [01:01:00 06/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 121 u1: mmHg rs: Final st: NotStopd t0: [01:01:00 06/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.58 rs: Final st: NotStopd
t0: [02:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [02:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 63 u1: BPM st: NotStopd t0: [02:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 120 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [02:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [02:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 39 u1: BPM st: NotStopd t0: [02:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 06/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 50 vu: ml t0: [02:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [02:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [02:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 06/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 250 cv: 250 ap: none t0: [23:00:00 06/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -174 cv: -174 ap: none t0: [23:00:00 06/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 16 cv: 784 ap: none t0: [23:00:00 06/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 76 cv: 2394 ap: none t0: [23:00:00 06/01/2016] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: 3161 cv: 170 ap: none t0: [23:00:00 06/01/2016] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN pv: 60 cv: 1440 ap: none t0: [23:00:00 06/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 250 cv: 2675 ap: none t0: [23:00:00 06/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -174 cv: -281 ap: carryForward t0: [23:00:00 06/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 250 cv: 2675 ap: carryForward
t0: [02:09:00 06/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.47 rs: Final st: NotStopd t0: [02:09:00 06/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 11 rs: Final st: NotStopd t0: [02:09:00 06/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 37 rs: Final st: NotStopd t0: [02:09:00 06/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 49 u1: mmHg rs: Final st: NotStopd t0: [02:09:00 06/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 145 u1: mmHg rs: Final st: NotStopd t0: [02:09:00 06/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.47 rs: Final st: NotStopd
t0: [23:00:00 06/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -174 cv: -1168.46 ap: carryForward
t0: [04:29:00 06/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.5 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 13.5 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 30.8 u1: % rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 9 u1: gm/dl rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 591 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.32 u1: /mic l rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.5 rs: Final st: NotStopd
t0: [05:00:00 06/01/2016] id: RSBI (<100) el: 0 cu: CSRU cg: RRT v1: 200 u1: units st: NotStopd t0: [05:00:00 06/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [05:00:00 06/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [05:00:00 06/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [05:00:00 06/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [05:00:00 06/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [05:00:00 06/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:00:00 06/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [05:00:00 06/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.4 u1: Deg. C st: NotStopd t0: [05:00:00 06/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 06/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [05:00:00 06/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:00:00 06/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:00:00 06/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [05:00:00 06/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.5 u1: L/min st: NotStopd t0: [05:00:00 06/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 06/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 06/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 18 u1: . st: NotStopd t0: [05:00:00 06/01/2016] id: RSBI (<200) el: 0 cu: CSRU cg: RRT v1: 200 u1: units st: NotStopd t0: [05:00:00 06/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [05:00:00 06/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [05:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [05:00:00 06/01/2016] id: Spon RR (Mech.) el: 0 cu: CSRU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [05:00:00 06/01/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: CSRU cg: RRT v1: 0.225 u1: L st: NotStopd t0: [05:00:00 06/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [05:00:00 06/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [05:00:00 06/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 317 u1: ml/B st: NotStopd t0: [05:00:00 06/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: CPAP+PS st: NotStopd t0: [05:00:00 06/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [04:29:00 06/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 27 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 95 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 97 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 27 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 35 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 95 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 97 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 137 rs: Final st: NotStopd
t0: [04:29:00 06/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd
t0: [00:00:00 06/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 06/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 06/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 06/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 06/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 06/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 06/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [00:00:00 06/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 06/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 14 u1: points st: NotStopd t0: [00:00:00 06/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 06/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 06/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 06/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 06/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 06/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 06/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 06/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 06/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 06/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 06/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 06/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 06/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 06/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 06/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 06/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 06/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 06/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 06/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 06/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [00:00:00 06/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 06/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 06/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 06/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [00:00:00 06/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [00:00:00 06/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [02:00:00 06/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [02:00:00 06/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [02:00:00 06/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [02:00:00 06/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [02:00:00 06/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [03:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [03:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [03:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 122 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [03:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [03:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [03:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 06/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 06/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [04:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 06/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 06/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 06/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 06/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 06/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [04:00:00 06/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 06/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [04:00:00 06/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 06/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 06/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 06/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [04:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 06/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 06/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 06/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 06/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 06/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 06/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 06/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 06/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 06/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 06/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 06/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 06/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 06/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [04:00:00 06/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 06/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 06/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [04:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [04:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [04:00:00 06/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 06/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 06/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 06/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 43 u1: BPM st: NotStopd t0: [04:00:00 06/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 06/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 06/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [04:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 06/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 06/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [04:00:00 06/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [04:00:00 06/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [04:00:00 06/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 06/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 06/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [04:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 06/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [04:00:00 06/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:29:00 06/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: RN v1: 3.8 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: RN v1: 3.8 rs: Final st: NotStopd t0: [05:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [05:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 06/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [05:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 06/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 06/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [05:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 130 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [05:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [05:00:00 06/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [05:00:00 06/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [05:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [05:00:00 06/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [05:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [06:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [06:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 123 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [06:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [06:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [06:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 06/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [05:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 15 vu: ml t0: [05:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 33 vu: ml t0: [05:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 180 vu: ml t0: [06:00:00 06/01/2016] id: D5W 50.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 109 vo: 50 vu: ml t0: [06:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [06:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [03:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [04:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [05:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [06:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 06/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: -1 vo: 0 st: D/C'd
t0: [07:19:00 06/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [07:19:00 06/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd
t0: [07:19:00 06/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 73 rs: Final st: NotStopd t0: [07:19:00 06/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 73 rs: Final st: NotStopd
t0: [08:00:00 06/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 06/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [08:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 06/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 06/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 06/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 06/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RN v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 06/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 06/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 06/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 06/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 06/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 06/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 06/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 06/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 06/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [08:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 06/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 06/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 06/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 06/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 06/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 06/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 06/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 06/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 06/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 06/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 06/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 06/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 06/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 06/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 06/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 06/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 06/01/2016] id: Airway Size el: 0 cu: CSRU cg: RN v1: 7.5 mm st: NotStopd t0: [08:00:00 06/01/2016] id: Airway Type el: 0 cu: CSRU cg: RN v1: Endotracheal st: NotStopd t0: [08:00:00 06/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 06/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 06/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RN v1: 12 v2: 23 st: NotStopd t0: [08:00:00 06/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 06/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 06/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [08:00:00 06/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 06/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 06/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 138 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [08:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [08:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 06/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 06/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 06/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 39 u1: BPM st: NotStopd t0: [08:00:00 06/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 06/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 06/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: White v2: Thick st: NotStopd t0: [08:00:00 06/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 06/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 06/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 06/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 06/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RN v1: Drager st: NotStopd t0: [08:00:00 06/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 06/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 06/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [09:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [09:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [09:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 06/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [09:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 158 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [09:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [09:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 44 u1: BPM st: NotStopd t0: [09:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [18:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [20:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [21:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [22:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [23:00:00 05/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [00:00:00 06/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [01:00:00 06/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [02:00:00 06/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [05:00:00 06/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [06:00:00 06/01/2016] id: bumex Free Form Intake el: 1 cu: CSRU cg: RN vu: ml t0: [08:00:00 06/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 0 vu: ml t0: [08:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 22 vu: ml t0: [08:00:00 06/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 90 vu: ml t0: [08:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 120 vu: ml t0: [09:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [09:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [08:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [09:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [10:00:00 06/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [10:00:00 06/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [10:00:00 06/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [10:00:00 06/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [10:00:00 06/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [10:00:00 06/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [10:00:00 06/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [10:00:00 06/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.9 u1: Deg. C st: NotStopd t0: [10:00:00 06/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [10:00:00 06/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [10:00:00 06/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [10:00:00 06/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [10:00:00 06/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [10:00:00 06/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.5 u1: L/min st: NotStopd t0: [10:00:00 06/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [10:00:00 06/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [10:00:00 06/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 18 u1: . st: NotStopd t0: [10:00:00 06/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [10:00:00 06/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [10:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [10:00:00 06/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [10:00:00 06/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [10:00:00 06/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [10:00:00 06/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: CPAP+PS st: NotStopd t0: [10:00:00 06/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 06/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 06/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 06/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 06/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [08:00:00 06/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [10:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [10:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 06/01/2016] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [10:00:00 06/01/2016] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [10:00:00 06/01/2016] id: Education Readiness el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 06/01/2016] id: Education Response el: 0 cu: CSRU cg: RN v1: Understands st: NotStopd t0: [10:00:00 06/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [10:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 63 u1: BPM st: NotStopd t0: [10:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 133 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [10:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [10:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [10:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 06/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [11:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [11:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 06/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [11:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 06/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [11:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 06/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [11:00:00 06/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [11:00:00 06/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [11:00:00 06/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [11:00:00 06/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [11:00:00 06/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [11:00:00 06/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [11:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [11:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 06/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [11:00:00 06/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Chair st: NotStopd t0: [11:00:00 06/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 06/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 06/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [11:00:00 06/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [11:00:00 06/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [11:00:00 06/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [11:00:00 06/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [11:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 143 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [11:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [11:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 06/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 06/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [11:00:00 06/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [11:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [11:00:00 06/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [11:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 06/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [11:00:00 06/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:00:00 06/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [11:00:00 06/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [11:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 06/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [11:00:00 06/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [11:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 22 vu: ml t0: [11:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 120 vu: ml
t0: [10:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [11:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 06/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 06/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [12:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [12:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [12:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 50 u1: BPM st: NotStopd t0: [12:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 06/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 06/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [12:00:00 06/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [12:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 06/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 109 rs: Manual st: NotStopd
t0: [12:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [12:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [12:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:45:00 06/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [12:45:00 06/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:45:00 06/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:45:00 06/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:45:00 06/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [12:45:00 06/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:45:00 06/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [12:45:00 06/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.8 u1: Deg. C st: NotStopd t0: [12:45:00 06/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:45:00 06/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [12:45:00 06/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:45:00 06/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: a v2: Atrovent st: NotStopd t0: [12:45:00 06/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [12:45:00 06/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [12:45:00 06/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:45:00 06/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [12:45:00 06/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 18 u1: . st: NotStopd t0: [12:45:00 06/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [12:45:00 06/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [12:45:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [12:45:00 06/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 322 u1: ml/B st: NotStopd t0: [12:45:00 06/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:45:00 06/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [13:00:00 06/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RT v1: 0.3 u1: torr st: NotStopd t0: [13:00:00 06/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RT v1: 9.2 u1: L/min st: NotStopd t0: [13:00:00 06/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RT v1: 5 u1: cmH2O st: NotStopd t0: [13:00:00 06/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RT v1: 15 u1: . st: NotStopd t0: [13:00:00 06/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RT v1: 31 u1: BPM st: NotStopd t0: [13:00:00 06/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RT v1: 300 u1: ml/B st: NotStopd t0: [13:00:00 06/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RT v1: CPAP+PS st: NotStopd
t0: [13:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [13:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [13:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 138 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [13:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [13:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 50 u1: BPM st: NotStopd t0: [13:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [13:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [13:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [13:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [14:00:00 16/01/2016] pt: Unit Dose rt: PO fr: HS:PRN m1: traZODONE HCl v1: 50 u1: mg tf: [14:00:00 16/01/2016] pt: Unit Dose rt: PO fr: HS:PRN m1: Zolpidem Tartrate v1: 10 u1: mg
t0: [14:00:00 06/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [14:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 06/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [14:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 06/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 06/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 06/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [14:00:00 06/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 06/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [14:00:00 06/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [14:00:00 06/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [14:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 06/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [14:00:00 06/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 06/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [14:00:00 06/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [14:00:00 06/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 06/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 06/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [14:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 145 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [14:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [14:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 06/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 06/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [14:00:00 06/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [14:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 58 u1: BPM st: NotStopd t0: [14:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 06/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 06/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 06/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [14:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 06/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [14:00:00 06/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [14:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [14:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [14:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [16:00:00 06/01/2016] pt: Unit Dose rt: PO fr: ONCE fs: 15 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq tf: [14:00:00 07/01/2016] pt: Unit Dose rt: PO fr: ONCE fs: 15 dn: 1 m1: Magnesium Oxide v1: 400 u1: mg
t0: [15:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [15:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 140 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [15:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [15:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 38 u1: BPM st: NotStopd t0: [15:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [15:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [15:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 06/01/2016] id: high min. vol el: 0 cu: CSRU cg: RT v1: 17 t0: [16:00:00 06/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RT v1: 23cm v2: Lip st: NotStopd t0: [16:00:00 06/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 06/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RT v1: 40 u1: cmH2O st: NotStopd t0: [16:00:00 06/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RT v1: 55 u1: BPM st: NotStopd t0: [16:00:00 06/01/2016] id: Airway Size el: 0 cu: CSRU cg: RT v1: 7.5 mm st: NotStopd t0: [16:00:00 06/01/2016] id: Airway Type el: 0 cu: CSRU cg: RT v1: Endotracheal st: NotStopd t0: [16:00:00 06/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RT v1: 33.8 u1: Deg. C st: NotStopd t0: [16:00:00 06/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 06/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RT v1: 4.5 st: NotStopd t0: [16:00:00 06/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 06/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 06/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RT v1: 8 u1: cmH2O st: NotStopd t0: [16:00:00 06/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RT v1: 11 u1: L/min st: NotStopd t0: [16:00:00 06/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 06/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RT v1: 20 st: NotStopd t0: [16:00:00 06/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RT v1: 12 u1: . st: NotStopd t0: [16:00:00 06/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RT v1: 35 u1: BPM st: NotStopd t0: [16:00:00 06/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RT v1: 4 u1: cmH2O st: NotStopd t0: [16:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RT v1: 99 u1: % st: NotStopd t0: [16:00:00 06/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RT v1: Tan v2: Thick st: NotStopd t0: [16:00:00 06/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RT v1: Suctioned v2: Small st: NotStopd t0: [16:00:00 06/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RT v1: 316 u1: ml/B st: NotStopd t0: [16:00:00 06/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RT v1: CPAP+PS st: NotStopd t0: [16:00:00 06/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RT v1: Drager st: NotStopd
t0: [16:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [16:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 06/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 06/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [16:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 143 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [16:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [16:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 37 u1: BPM st: NotStopd t0: [16:00:00 06/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 06/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [16:00:00 06/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [16:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 06/01/2016] tf: [17:00:00 07/01/2016] dt: 1500 id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 5 vu: ml t0: [16:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [16:00:00 06/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 30 vu: ml t0: [16:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [16:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:29:00 06/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: RN v1: 1.7 rs: Final st: NotStopd t0: [04:29:00 06/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: RN v1: 1.7 rs: Final st: NotStopd t0: [17:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [17:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [17:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 149 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [17:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [17:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [17:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [17:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [17:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [16:00:00 07/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 17 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [22:00:00 04/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [03:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [04:00:00 05/01/2016] id: Previous Weight el: 0 cu: CSRU cg: 3161 v1: 61.9 u1: kg st: NotStopd t0: [04:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [06:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [08:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [10:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [13:00:00 05/01/2016] id: Previous Weight el: 0 cu: CSRU cg: 3161 v1: 61.9 u1: kg st: NotStopd t0: [13:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [16:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [17:00:00 05/01/2016] id: Previous Weight el: 0 cu: CSRU cg: 3161 v1: 61.9 u1: kg st: NotStopd t0: [17:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [18:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [21:00:00 05/01/2016] id: Previous Weight el: 0 cu: CSRU cg: 3161 v1: 61.9 u1: kg st: NotStopd t0: [21:00:00 05/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [00:00:00 06/01/2016] id: Previous Weight el: 0 cu: CSRU cg: 3161 v1: 61.9 u1: kg st: NotStopd t0: [00:00:00 06/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: 3161 u1: kg st: NotStopd t0: [17:22:00 06/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.48 rs: Final st: NotStopd t0: [17:22:00 06/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 8 rs: Final st: NotStopd t0: [17:22:00 06/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 33 rs: Final st: NotStopd t0: [17:22:00 06/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 43 u1: mmHg rs: Final st: NotStopd t0: [17:22:00 06/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 143 u1: mmHg rs: Final st: NotStopd t0: [17:22:00 06/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.48 rs: Final st: NotStopd
t0: [17:00:00 06/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [17:00:00 06/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [17:00:00 06/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [17:00:00 06/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [17:00:00 06/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [17:00:00 06/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [17:00:00 06/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [17:00:00 06/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [17:00:00 06/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [17:00:00 06/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [17:00:00 06/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [17:00:00 06/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [17:00:00 06/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [17:00:00 06/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [17:00:00 06/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [17:00:00 06/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [17:00:00 06/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [17:00:00 06/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [17:00:00 06/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [17:00:00 06/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [17:00:00 06/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [17:00:00 06/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [17:00:00 06/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [17:00:00 06/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [18:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [18:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [18:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 157 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [18:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [18:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [18:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [18:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 06/01/2016] dt: 24 id: Stool Out Total el: 3 cu: CSRU cg: RN cv: 0 ap: carryForward
t0: [19:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [19:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [19:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 154 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [19:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [19:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [19:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [20:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [20:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 154 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [20:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [20:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [20:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [20:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 22 vu: ml t0: [20:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 120 vu: ml
t0: [19:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [20:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 06/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [20:00:00 06/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [20:00:00 06/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 06/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 06/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [20:00:00 06/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 06/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 06/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.7 u1: Deg. C st: NotStopd t0: [20:00:00 06/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 06/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4.5 st: NotStopd t0: [20:00:00 06/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 06/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 06/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:00:00 06/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [20:00:00 06/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 06/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 06/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 12 u1: . st: NotStopd t0: [20:00:00 06/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [20:00:00 06/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [20:00:00 06/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 06/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 06/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 342 u1: ml/B st: NotStopd t0: [20:00:00 06/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 06/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 06/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 06/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 06/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 06/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 06/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 06/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 06/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [20:00:00 06/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 06/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 06/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 06/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 06/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 06/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 06/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 06/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 06/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 06/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 06/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 06/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 06/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 06/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 06/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 06/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 06/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 06/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 06/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 06/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 06/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 06/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 06/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 06/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 06/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [20:00:00 06/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 06/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 06/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 06/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 06/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 06/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 06/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 06/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 06/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 06/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 06/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 06/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 06/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 06/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 06/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [20:00:00 06/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [21:00:00 06/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [21:00:00 06/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [21:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [21:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 06/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 06/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [21:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 06/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [21:00:00 06/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [21:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 167 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [21:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [21:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [21:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 06/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [21:00:00 06/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2778 u1: Deg. C st: NotStopd t0: [21:00:00 06/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.3 u1: Deg. F st: NotStopd t0: [21:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [21:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [21:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [20:00:00 06/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 06/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 06/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [20:00:00 06/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 06/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 06/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 06/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Red st: NotStopd t0: [20:00:00 06/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Open v2: Clean and Dry st: NotStopd t0: [20:00:00 06/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 06/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 06/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 06/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [20:00:00 06/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [20:00:00 06/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 06/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [20:00:00 06/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [20:00:00 06/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 06/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 06/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [20:00:00 06/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 06/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 18 u1: number st: NotStopd t0: [20:00:00 06/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: No Impairment st: NotStopd t0: [22:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:00:00 06/01/2016] id: Chest PT R/L el: 0 cu: CSRU cg: RN v1: Done v2: Done st: NotStopd t0: [22:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 06/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 06/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 06/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [22:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 06/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 06/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [22:00:00 06/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 177 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [22:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [22:00:00 06/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [22:00:00 06/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [22:00:00 06/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 06/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: White v2: Thick st: NotStopd t0: [22:00:00 06/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [22:00:00 06/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [22:00:00 06/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [22:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [22:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 06/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:00:00 06/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 06/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [23:00:00 06/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 06/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: Occasional st: NotStopd t0: [23:00:00 06/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: PVC's st: NotStopd t0: [23:00:00 06/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [23:00:00 06/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 06/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 149 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [23:00:00 06/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [23:00:00 06/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 06/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [23:00:00 06/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 06/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 06/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 06/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [23:00:00 06/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [23:00:00 06/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 06/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [23:00:00 06/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [23:00:00 06/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [23:00:00 06/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [23:00:00 06/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [23:00:00 06/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [23:00:00 06/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [23:00:00 06/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.7 u1: Deg. C st: NotStopd t0: [23:00:00 06/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [23:00:00 06/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4.5 st: NotStopd t0: [23:00:00 06/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [23:00:00 06/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [23:00:00 06/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [23:00:00 06/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.5 u1: L/min st: NotStopd t0: [23:00:00 06/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [23:00:00 06/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [23:00:00 06/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 15 u1: . st: NotStopd t0: [23:00:00 06/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [23:00:00 06/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [23:00:00 06/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [23:00:00 06/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [00:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 07/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 07/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: Occasional st: NotStopd t0: [00:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: PVC's st: NotStopd t0: [00:00:00 07/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 07/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [00:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 132 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [00:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [00:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [00:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [00:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [00:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [00:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [00:00:00 07/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 07/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 07/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 07/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 07/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 07/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [00:00:00 07/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 07/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 07/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 07/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 07/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 07/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 07/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 07/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [00:00:00 07/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 07/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 07/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 07/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Open v2: Clean and Dry st: NotStopd t0: [00:00:00 07/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 07/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 07/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 07/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 07/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 07/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 07/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 07/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 07/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 07/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 07/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 07/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 07/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 07/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 07/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 07/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 07/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 07/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 07/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 07/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [00:00:00 07/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [00:00:00 07/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 10 vu: ml
tf: [00:00:00 08/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 1 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [01:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [01:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 07/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [01:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 138 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [01:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [01:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 23 u1: BPM st: NotStopd t0: [01:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [01:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [01:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [01:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [02:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [02:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [02:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 160 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [02:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [02:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [02:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [02:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [02:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [02:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 07/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 305 cv: 305 ap: none t0: [23:00:00 07/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: 136.875 cv: 136.875 ap: none t0: [23:00:00 07/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 118.875 cv: 4051.04 ap: none t0: [23:00:00 07/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 441.875 cv: 7923.04 ap: none t0: [23:00:00 07/01/2016] dt: 24 id: Tube Feeds In Total el: 3 cu: CSRU cg: RN cv: 820 ap: none t0: [23:00:00 07/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 15 cv: 1734 ap: none t0: [23:00:00 07/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: 136.875 cv: 4424.04 ap: carryForward t0: [23:00:00 07/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 305 cv: 3499 ap: carryForward t0: [23:00:00 07/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: 136.875 cv: 3255.58 ap: carryForward
t0: [04:00:00 07/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [04:00:00 07/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [04:00:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 07/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:00:00 07/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [04:00:00 07/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 07/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 07/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.9 u1: Deg. C st: NotStopd t0: [04:00:00 07/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 07/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4.5 st: NotStopd t0: [04:00:00 07/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 07/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 07/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:00:00 07/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.02 u1: L/min st: NotStopd t0: [04:00:00 07/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 07/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 07/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 15 u1: . st: NotStopd t0: [04:00:00 07/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [04:00:00 07/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [04:00:00 07/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 07/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 07/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 338 u1: ml/B st: NotStopd t0: [04:00:00 07/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [22:00:00 06/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [22:00:00 06/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 07/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 07/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [00:00:00 07/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [00:00:00 07/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [00:00:00 07/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 07/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [00:00:00 07/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 07/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 07/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 07/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [01:00:00 07/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 07/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 07/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [01:00:00 07/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [01:00:00 07/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [01:00:00 07/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [01:00:00 07/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 07/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [02:00:00 07/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [02:00:00 07/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 15 u1: points st: NotStopd t0: [02:00:00 07/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [02:00:00 07/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [02:00:00 07/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Oriented x 3 st: NotStopd t0: [02:00:00 07/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 5 Oriented st: NotStopd t0: [03:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [03:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 07/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [03:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [03:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 145 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [03:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [03:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 43 u1: BPM st: NotStopd t0: [03:00:00 07/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [03:00:00 07/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [03:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 07/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 07/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [04:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 07/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 07/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 07/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 07/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 07/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 07/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 07/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 07/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 07/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [04:00:00 07/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 07/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 07/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 07/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 07/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [04:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 07/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 07/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 07/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [04:00:00 07/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [04:00:00 07/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [04:00:00 07/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 07/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [04:00:00 07/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 07/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 07/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 07/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 07/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 07/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 07/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Open v2: Clean and Dry st: NotStopd t0: [04:00:00 07/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 07/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 07/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 07/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 07/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 07/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 07/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [04:00:00 07/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 07/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 136 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [04:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [04:00:00 07/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 07/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 07/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [04:00:00 07/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [04:00:00 07/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 07/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 07/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 07/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 07/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 07/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.7222 u1: Deg. C st: NotStopd t0: [04:00:00 07/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.3 u1: Deg. F st: NotStopd t0: [04:00:00 07/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 07/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 07/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [04:00:00 07/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Chairfast st: NotStopd t0: [04:00:00 07/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 07/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 07/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 07/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [04:00:00 07/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 17 u1: number st: NotStopd t0: [04:00:00 07/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: No Impairment st: NotStopd t0: [04:00:00 07/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [04:00:00 07/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 5 vu: ml t0: [04:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 22 vu: ml t0: [04:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 120 vu: ml
t0: [03:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip t0: [04:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [04:40:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.48 rs: Final st: NotStopd t0: [04:40:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 13 rs: Final st: NotStopd t0: [04:40:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 40 rs: Final st: NotStopd t0: [04:40:00 07/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 52 u1: mmHg rs: Final st: NotStopd t0: [04:40:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 127 u1: mmHg rs: Final st: NotStopd t0: [04:40:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.48 rs: Final st: NotStopd
t0: [05:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [05:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [05:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 119 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [05:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [05:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [05:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [05:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [05:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [05:19:00 07/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.8 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 13.8 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 31.6 u1: % rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 9.9 u1: gm/dl rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 633 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.34 u1: /mic l rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.8 rs: Final st: NotStopd
t0: [05:19:00 07/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.3 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.5 u1: mg/dl rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 95 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 84 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 87.1 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.2 u1: mEq/L rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.4 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.5 u1: mg/dl rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 38 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 95 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 84 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.3 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 87.1 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.2 u1: mEq/L rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.4 rs: Final st: NotStopd t0: [05:19:00 07/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd
t0: [06:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [06:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 07/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 07/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [06:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [06:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 07/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 07/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [06:00:00 07/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [06:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 153 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [06:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [06:00:00 07/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [06:00:00 07/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 07/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [06:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [06:00:00 07/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 07/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [06:00:00 07/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [06:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [06:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [06:25:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.45 rs: Final st: NotStopd t0: [06:25:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 14 rs: Final st: NotStopd t0: [06:25:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 42 rs: Final st: NotStopd t0: [06:25:00 07/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 58 u1: mmHg rs: Final st: NotStopd t0: [06:25:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 122 u1: mmHg rs: Final st: NotStopd t0: [06:25:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.45 rs: Final st: NotStopd
t0: [07:00:00 07/01/2016] id: Drain Out #1 Other el: 1 cu: CSRU cg: -1 vo: 0 st: D/C'd
t0: [07:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [07:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 07/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [07:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [07:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 147 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [07:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [07:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 38 u1: BPM st: NotStopd t0: [07:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [07:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [07:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1100 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [08:00:00 07/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 07/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [08:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 07/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 07/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 07/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 07/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 07/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 07/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 07/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 07/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 07/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [08:00:00 07/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 07/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 07/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 07/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 07/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 07/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 07/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [08:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 07/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 07/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 07/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 07/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 07/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [08:00:00 07/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 07/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [08:00:00 07/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 07/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 07/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 07/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 07/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 07/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 07/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 07/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 07/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 07/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 07/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 07/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 07/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [08:00:00 07/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [08:00:00 07/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 07/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 07/01/2016] id: Orientation el: 0 cu: CSRU cg: RN st: NotStopd t0: [08:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 130 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [08:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [08:00:00 07/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 07/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 07/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Bronchial st: NotStopd t0: [08:00:00 07/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [08:00:00 07/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 07/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 07/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 07/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 07/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [08:00:00 07/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.2 u1: Deg. F st: NotStopd t0: [08:00:00 07/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 07/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 07/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 07/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Calm st: NotStopd t0: [08:00:00 07/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Present st: NotStopd t0: [08:00:00 07/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd
t0: [08:00:00 07/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: RN ai: 209 vo: 50 vu: ml t0: [08:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 11 vu: ml t0: [08:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [08:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
tf: [07:00:00 08/01/2016] pt: Unit Dose rt: PO fr: ONCE fs: 8 dn: 1 m1: Potassium Chloride v1: 60 u1: mEq
t0: [08:00:00 07/01/2016] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Brown v2: Soft st: NotStopd t0: [08:00:00 07/01/2016] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd
t0: [08:00:00 07/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 17 t0: [08:00:00 07/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [08:00:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 07/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 07/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [08:00:00 07/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 07/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 07/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [08:00:00 07/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 07/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4.5 st: NotStopd t0: [08:00:00 07/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 07/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 07/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [08:00:00 07/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.9 u1: L/min st: NotStopd t0: [08:00:00 07/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 07/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 07/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 12 u1: . st: NotStopd t0: [08:00:00 07/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [08:00:00 07/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 07/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [08:00:00 07/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 07/01/2016] id: Tidal Volume (Spont) el: 0 cu: CSRU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:00:00 07/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [09:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [09:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [09:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 124 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [09:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [09:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [09:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [09:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [09:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [09:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [10:00:00 07/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 12 u1: . st: NotStopd
t0: [10:15:00 07/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 15 u1: . st: NotStopd
t0: [10:15:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd
t0: [10:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [10:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 77 u1: BPM st: NotStopd t0: [10:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 156 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [10:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [10:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 63 u1: BPM st: NotStopd t0: [10:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 93 u1: % st: NotStopd t0: [10:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [10:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [10:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [10:00:00 07/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [10:00:00 07/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [10:53:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.37 rs: Final st: NotStopd t0: [10:53:00 07/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 12.2674 u1: ml/dl st: NotStopd t0: [10:53:00 07/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.6 rs: Final st: NotStopd t0: [10:53:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 9 rs: Final st: NotStopd t0: [10:53:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 40 rs: Final st: NotStopd t0: [10:53:00 07/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 67 u1: mmHg rs: Final st: NotStopd t0: [10:53:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 63 u1: mmHg rs: Final st: NotStopd t0: [10:53:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.37 rs: Final st: NotStopd t0: [10:53:00 07/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.6 rs: Final st: NotStopd t0: [10:53:00 07/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 91 u1: % rs: Final st: NotStopd
t0: [11:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [11:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [11:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 133 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [11:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [11:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 41 u1: BPM st: NotStopd t0: [11:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 90 u1: % st: NotStopd t0: [11:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml t0: [11:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 60 vu: ml
t0: [11:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [11:00:00 07/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:00:00 07/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:00:00 07/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 20 u1: . st: NotStopd
tf: [08:00:00 08/01/2016] pt: Unit Dose rt: PO fr: PRN m1: Potassium Chloride v1: 40 u1: mEq tf: [11:00:00 08/01/2016] pt: Unit Dose rt: IH fr: 1X fs: 12 m1: Albuterol-Ipratropium v1: 1-2 u1: PUFF
t0: [09:00:00 07/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 07/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 07/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [09:00:00 07/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 07/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [09:00:00 07/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [09:00:00 07/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [10:30:00 07/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [10:30:00 07/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Fair st: NotStopd t0: [10:30:00 07/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [10:30:00 07/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [10:30:00 07/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [11:50:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [11:50:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:50:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:50:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 85 u1: BPM st: NotStopd t0: [11:50:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg v2: 33 u2: mmHg st: NotStopd t0: [11:50:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [11:50:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [11:50:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [11:50:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:50:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 45 u1: BPM st: NotStopd t0: [11:50:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 92 u1: % st: NotStopd t0: [11:50:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 80 u1: BPM st: NotStopd t0: [12:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [12:00:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 74.3333 u1: mmHg st: NotStopd t0: [12:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg v2: 41 u2: mmHg st: NotStopd t0: [12:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 51 u1: mmHg st: NotStopd t0: [12:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 41 u1: BPM st: NotStopd t0: [12:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 93 u1: % st: NotStopd t0: [12:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:05:00 07/01/2016] id: Significant Events el: 0 cu: CSRU cg: RN v1: Fluid Bolus st: NotStopd
t0: [12:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml
t0: [11:50:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [12:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 07/01/2016] dt: 24 id: Stool Out Total el: 3 cu: CSRU cg: RN cv: 0 ap: carryForward
t0: [12:30:00 07/01/2016] id: Pressure Support el: 0 cu: CSRU cg: RRT v1: 25 u1: . st: NotStopd
t0: [12:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RRT ai: 168 vo: 10 vu: ml t0: [12:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RRT ai: 199 vo: 60 vu: ml
t0: [12:00:00 07/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 11.1111 u1: ml/cmH st: NotStopd t0: [12:00:00 07/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [12:00:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 1 u1: torr st: NotStopd t0: [12:00:00 07/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 07/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 07/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 07/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [12:00:00 07/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.9 u1: L/min st: NotStopd t0: [12:00:00 07/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 07/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [12:00:00 07/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [12:00:00 07/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [12:00:00 07/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [12:00:00 07/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [12:00:00 07/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [12:00:00 07/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:00:00 07/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Assist Control st: NotStopd t0: [12:00:00 07/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [12:55:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.37 rs: Final st: NotStopd t0: [12:55:00 07/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [12:55:00 07/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.2 rs: Final st: NotStopd t0: [12:55:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 6 rs: Final st: NotStopd t0: [12:55:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 35 rs: Final st: NotStopd t0: [12:55:00 07/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 58 u1: mmHg rs: Final st: NotStopd t0: [12:55:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 123 u1: mmHg rs: Final st: NotStopd t0: [12:55:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.37 rs: Final st: NotStopd t0: [12:55:00 07/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.33 rs: Final st: NotStopd t0: [12:55:00 07/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [12:55:00 07/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.2 rs: Final st: NotStopd
id: Neosynephrine-k el: 200 cu: CSRU cg: RN io: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions am: 60 du: mcgkgmin rt: IV Drip
id: D5W el: 2 cu: CSRU cg: RN io: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [12:10:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:10:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:10:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:10:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:10:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [12:10:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:10:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [12:10:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [12:10:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 55 u1: mmHg v2: 35 u2: mmHg st: NotStopd t0: [12:10:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 38 u1: mmHg st: NotStopd t0: [12:10:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:10:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [12:10:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 91 u1: % st: NotStopd t0: [12:10:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:25:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:25:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:25:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:25:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [12:25:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 56 u1: mmHg v2: 30 u2: mmHg st: NotStopd t0: [12:25:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 38.6667 u1: mmHg st: NotStopd t0: [12:25:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 53 u1: mmHg v2: 33 u2: mmHg st: NotStopd t0: [12:25:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [12:25:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:25:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [12:25:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 91 u1: % st: NotStopd t0: [12:25:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:30:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:30:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:30:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:30:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 48 u1: BPM st: NotStopd t0: [12:30:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN st: NotStopd t0: [12:30:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 52 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [12:30:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 32.6667 u1: mmHg st: NotStopd t0: [12:30:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [12:30:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 35 u1: mmHg st: NotStopd t0: [12:30:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:30:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 53 u1: BPM st: NotStopd t0: [12:30:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 80 u1: % st: NotStopd t0: [12:30:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:35:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [12:45:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:45:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:45:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:45:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: Nod/Junc Escape st: NotStopd t0: [12:45:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [12:45:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:45:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [12:45:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [12:45:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:45:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [12:45:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [12:45:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [13:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: PAC's st: NotStopd t0: [13:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [13:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 120 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [13:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [13:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [13:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:10:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [12:25:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip t0: [12:30:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1000 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 4.58333 vu: ml t0: [13:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 10 vu: ml
t0: [12:45:00 07/01/2016] tf: [09:53:00 12/01/2016] dt: 7028 id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [12:30:00 07/01/2016] id: Significant Events el: 0 cu: CSRU cg: RN v1: Cardiac Arrest st: NotStopd
t0: [13:00:00 07/01/2016] tf: [22:15:00 07/01/2016] dt: 555 id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [13:00:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 2.0625 vu: ml
t0: [13:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [13:00:00 07/01/2016] tf: [17:00:00 07/01/2016] dt: 240 id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vu: ml st: Stopped t0: [13:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vo: 40 vu: ml
t0: [12:40:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [12:45:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [13:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [12:56:00 07/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.7 rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 91.7 rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.7 rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 91.7 rs: Final st: NotStopd
t0: [12:56:00 07/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.9 rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 13.9 rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 26.3 u1: % rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 8.1 u1: gm/dl rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 724 rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 2.78 u1: /mic l rs: Final st: NotStopd t0: [12:56:00 07/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.9 rs: Final st: NotStopd
tf: [22:00:00 07/01/2016] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Norepinephrine v1: 4 u1: mg m2: D5W v2: 250 u2: ml tf: [14:00:00 13/01/2016] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Norepinephrine v1: 16 u1: mg m2: D5W v2: 250 u2: ml tf: [14:00:00 16/01/2016] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Norepinephrine v1: 4 u1: mg m2: D5W v2: 250 u2: ml
id: .9% Normal Saline el: 2 cu: CSRU cg: RN io: .9% Normal Saline 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push
t0: [13:00:00 07/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [13:30:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [13:30:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:30:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:30:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 84 u1: BPM st: NotStopd t0: [13:30:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:30:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [13:30:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [13:30:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:30:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [13:30:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 91 u1: % st: NotStopd t0: [13:30:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [14:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 82 u1: BPM st: NotStopd t0: [14:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 07/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [14:00:00 07/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [14:00:00 07/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [14:00:00 07/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [14:00:00 07/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [14:00:00 07/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [14:00:00 07/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Dampened st: NotStopd t0: [14:00:00 07/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 07/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [14:00:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [14:00:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [14:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [14:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [14:00:00 07/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [14:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [14:00:00 07/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:30:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [14:30:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:30:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:30:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:30:00 07/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [14:30:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 81 u1: BPM st: NotStopd t0: [14:30:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:30:00 07/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [14:30:00 07/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [14:30:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [14:30:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 63.6667 u1: mmHg st: NotStopd t0: [14:30:00 07/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:30:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [14:30:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [14:30:00 07/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [14:30:00 07/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:30:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:30:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [14:30:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 95 u1: % st: NotStopd t0: [14:30:00 07/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [14:30:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 0 vu: ml t0: [14:00:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 8.25 vu: ml
t0: [13:30:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.75 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:30:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [14:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [14:30:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:30:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [13:15:00 07/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [13:15:00 07/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [13:15:00 07/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Changed st: NotStopd t0: [13:15:00 07/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [13:15:00 07/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [14:00:00 07/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 07/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 07/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [14:00:00 07/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [14:00:00 07/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 4 Spontaneously st: NotStopd t0: [14:00:00 07/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 11 u1: points st: NotStopd t0: [14:00:00 07/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 07/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [14:00:00 07/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [14:00:00 07/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 07/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [14:00:00 07/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [14:00:00 07/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [14:00:00 07/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [14:00:00 07/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 07/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 07/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 07/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 07/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [14:00:00 07/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 07/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Alert st: NotStopd t0: [14:00:00 07/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 07/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 07/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [14:00:00 07/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 07/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 07/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [14:00:00 07/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 07/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 07/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 07/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 07/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [14:00:00 07/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [14:00:00 07/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [14:00:00 07/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [14:00:00 07/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Adequate st: NotStopd t0: [14:00:00 07/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 15 u1: number st: NotStopd t0: [14:00:00 07/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Sl. Limited st: NotStopd t0: [14:00:00 07/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [14:00:00 07/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 07/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 07/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd
t0: [15:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 82 u1: BPM st: NotStopd t0: [15:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 138 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [15:00:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 90.6667 u1: mmHg st: NotStopd t0: [15:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [15:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [15:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 13 u1: BPM st: NotStopd t0: [15:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [15:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:05:00 07/01/2016] tf: [03:00:00 08/01/2016] dt: 895 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vu: ml t0: [12:05:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 500 vu: ml t0: [14:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 1000 vu: ml nb: 1 t0: [14:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: RN ai: 199 vu: ml
t0: [15:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip
id: Levophed-k el: 200 cu: CSRU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions am: 4 du: mcgkgmin rt: IV Drip
id: D5W el: 2 cu: CSRU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [15:30:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:30:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:30:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:30:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:30:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 85 u1: BPM st: NotStopd t0: [15:30:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:30:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg v2: 35 u2: mmHg st: NotStopd t0: [15:30:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 49 u1: mmHg st: NotStopd t0: [15:30:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [15:30:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [15:30:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:30:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 48 u1: BPM st: NotStopd t0: [15:30:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [15:30:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:30:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:30:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [15:37:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.32 rs: Final st: NotStopd t0: [15:37:00 07/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 11.9018 u1: ml/dl st: NotStopd t0: [15:37:00 07/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [15:37:00 07/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [15:37:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [15:37:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 34 rs: Final st: NotStopd t0: [15:37:00 07/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 64 u1: mmHg rs: Final st: NotStopd t0: [15:37:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 373 u1: mmHg rs: Final st: NotStopd t0: [15:37:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.32 rs: Final st: NotStopd t0: [15:37:00 07/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [15:37:00 07/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.5 rs: Final st: NotStopd t0: [15:37:00 07/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 99 u1: % rs: Final st: NotStopd
t0: [15:46:00 07/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.8 rs: Final st: NotStopd t0: [15:46:00 07/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.8 rs: Final st: NotStopd
t0: [15:35:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:35:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:35:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:35:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:35:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 84 u1: BPM st: NotStopd t0: [15:35:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:35:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 125 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [15:35:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 98.3333 u1: mmHg st: NotStopd t0: [15:35:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [15:35:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 55 u1: mmHg st: NotStopd t0: [15:35:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:35:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 41 u1: BPM st: NotStopd t0: [15:35:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 82 u1: % st: NotStopd t0: [15:35:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:40:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:40:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:40:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:40:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:40:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 84 u1: BPM st: NotStopd t0: [15:40:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:40:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg v2: 40 u2: mmHg st: NotStopd t0: [15:40:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 52 u1: mmHg st: NotStopd t0: [15:40:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [15:40:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [15:40:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:40:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [15:40:00 07/01/2016] id: Significant Events el: 0 cu: CSRU cg: RN v1: Fluid Bolus st: NotStopd t0: [15:40:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 84 u1: % st: NotStopd t0: [15:40:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:45:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:45:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:45:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:45:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:45:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 83 u1: BPM st: NotStopd t0: [15:45:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:45:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [15:45:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [15:45:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN u1: mmHg u2: mmHg st: NotStopd t0: [15:45:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 35 u1: mmHg st: NotStopd t0: [15:45:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:45:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [15:45:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 78 u1: % st: NotStopd t0: [15:45:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [16:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 81 u1: BPM st: NotStopd t0: [16:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg v2: 39 u2: mmHg st: NotStopd t0: [16:00:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 49.6667 u1: mmHg st: NotStopd t0: [16:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [16:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 57 u1: mmHg st: NotStopd t0: [16:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [16:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:45:00 07/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 0 vu: ml t0: [16:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 0 vu: ml t0: [16:00:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 37.125 vu: ml
t0: [15:45:00 07/01/2016] tf: [09:53:00 12/01/2016] dt: 6848 id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:35:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [15:40:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:40:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [15:45:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:45:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:45:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [16:00:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.08 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [16:00:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 1 u1: torr st: NotStopd
t0: [16:30:00 07/01/2016] tf: [07:00:00 08/01/2016] dt: 870 id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 136 vu: ml
t0: [16:30:00 07/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 7.31707 u1: ml/cmH st: NotStopd t0: [16:30:00 07/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 13 t0: [16:30:00 07/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 23cm v2: Lip st: NotStopd t0: [16:30:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 1 u1: torr st: NotStopd t0: [16:30:00 07/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [16:30:00 07/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [16:30:00 07/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:1.7 st: NotStopd t0: [16:30:00 07/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:30:00 07/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [16:30:00 07/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.9 u1: Deg. C st: NotStopd t0: [16:30:00 07/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:30:00 07/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 4.5 st: NotStopd t0: [16:30:00 07/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [16:30:00 07/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [16:30:00 07/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.5 u1: L/min st: NotStopd t0: [16:30:00 07/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:30:00 07/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [16:30:00 07/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [16:30:00 07/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 46 u1: cmH2O st: NotStopd t0: [16:30:00 07/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [16:30:00 07/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [16:30:00 07/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [16:30:00 07/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [16:30:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 92 u1: % st: NotStopd t0: [16:30:00 07/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 305 u1: ml/B st: NotStopd t0: [16:30:00 07/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [16:30:00 07/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Assist Control st: NotStopd t0: [16:30:00 07/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [16:30:00 07/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [17:00:00 07/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [17:00:00 07/01/2016] id: ETT Position Change el: 0 cu: CSRU cg: RRT v1: Done st: NotStopd
t0: [17:00:00 07/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CSRU cg: -1 ai: 209 vo: 0 st: D/C'd t0: [17:00:00 07/01/2016] id: Tube Feeding PO/Gastric el: 1 cu: CSRU cg: -1 ai: 199 vo: 0 st: D/C'd
id: Hespan el: 1 cu: CSRU cg: RN io: Hespan IV Infusions du: ml rt: Intravenous Push
t0: [16:45:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [16:45:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:45:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:45:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 93 u1: BPM st: NotStopd t0: [16:45:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:45:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [16:45:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 65.3333 u1: mmHg st: NotStopd t0: [16:45:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [16:45:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [16:45:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:45:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 4 u1: BPM st: NotStopd t0: [16:45:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 93 u1: % st: NotStopd t0: [16:45:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [17:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 94 u1: BPM st: NotStopd t0: [17:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 104 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [17:00:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [17:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [17:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 48 u1: mmHg st: NotStopd t0: [17:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 38 u1: BPM st: NotStopd t0: [17:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:15:00 07/01/2016] tf: [18:00:00 09/01/2016] dt: 2985 id: Hespan IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 500 vu: ml t0: [17:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 07/01/2016] id: D5W 250.0ml + 25000Uhr Heparin IV Infusions el: 2 cu: CSRU cg: RN ai: 168 vo: 0 vu: ml t0: [17:00:00 07/01/2016] tf: [07:00:00 09/01/2016] dt: 2280 id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 21.0375 vu: ml t0: [17:00:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 20.625 vu: ml t0: [17:00:00 07/01/2016] id: Hespan IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 500 vu: ml
t0: [16:45:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.12 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:45:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:45:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip t0: [17:00:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.12 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [23:00:00 07/01/2016] dt: 24 id: Colloids Total el: 3 cu: CSRU cg: RN cv: 1000 ap: none
t0: [17:00:00 07/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 114 vu: ml
t0: [16:15:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [16:15:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:15:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:15:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:15:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 90 u1: BPM st: NotStopd t0: [16:15:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:15:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [16:15:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 67.3333 u1: mmHg st: NotStopd t0: [16:15:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [16:15:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [16:15:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:15:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [16:15:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 84 u1: % st: NotStopd t0: [16:15:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:15:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.08 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:15:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:15:00 07/01/2016] id: Heparin el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: Uhr sv: 250 su: ml rt: IV Drip
t0: [17:40:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 3 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 31 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 54 u1: mmHg rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 339 u1: mmHg rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd
t0: [17:47:00 07/01/2016] id: Blood Products Hematology el: 0 cu: CSRU cg: 3161 v1: Y rs: Final st: NotStopd
t0: [14:30:00 07/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [14:30:00 07/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd
t0: [17:15:00 07/01/2016] id: Radiologic Study el: 0 cu: CSRU cg: RN v1: Chest Xray st: NotStopd
t0: [13:45:00 07/01/2016] id: Radiologic Study el: 0 cu: CSRU cg: RN v1: Chest Xray st: NotStopd
tf: [14:00:00 09/01/2016] pt: IV Piggyback rt: IV fr: Q8H fs: 2, 10, 18 dn: 3 m1: Piperacillin-Tazobactam Na v1: 4.5 u1: gm m2: Iso-Osmotic Dextrose v2: 100 u2: ml tf: [14:00:00 15/01/2016] pt: Unit Dose rt: IV fr: Q4H:PRN m1: Fentanyl Citrate v1: 25-100 u1: mcg tf: [14:00:00 16/01/2016] pt: Unit Dose rt: IV fr: Q2H:PRN m1: Midazolam HCl v1: 1-2 u1: mg
id: Packed RBC's el: 2 cu: CSRU cg: RN io: Packed RBC's IV Infusions du: ml rt: Intravenous Push
t0: [18:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 07/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 29.7 vu: ml t0: [18:00:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 20.625 vu: ml t0: [18:00:00 07/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 115 vu: ml
t0: [17:15:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [17:15:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:15:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:15:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 93 u1: BPM st: NotStopd t0: [17:15:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [17:15:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 56.3333 u1: mmHg st: NotStopd t0: [17:15:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [17:15:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [17:15:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:15:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [17:15:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [17:15:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [18:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 91 u1: BPM st: NotStopd t0: [18:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [18:00:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 71.3333 u1: mmHg st: NotStopd t0: [18:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [18:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [18:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [18:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:15:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [18:15:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:15:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:15:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:15:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 91 u1: BPM st: NotStopd t0: [18:15:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:15:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [18:15:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 63.3333 u1: mmHg st: NotStopd t0: [18:15:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [18:15:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [18:15:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:15:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [18:15:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [18:15:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:15:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.16 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:15:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.16 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1.25 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:15:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:15:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [18:20:00 07/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [18:20:00 07/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.2778 u1: Deg. C st: NotStopd t0: [18:20:00 07/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 95.5 u1: Deg. F st: NotStopd
t0: [18:00:00 07/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [18:30:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [18:30:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:30:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:30:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 92 u1: BPM st: NotStopd t0: [18:30:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:30:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [18:30:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [18:30:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:30:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [18:30:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [18:30:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:30:00 07/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 85 vu: ml
t0: [18:30:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:30:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [18:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 250 vu: ml t0: [18:35:00 07/01/2016] tf: [18:00:00 09/01/2016] dt: 2845 id: Packed RBC's IV Infusions el: 2 cu: CSRU cg: RN ai: 155 vo: 375 vu: ml
t0: [18:35:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [18:35:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:35:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:35:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:35:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 91 u1: BPM st: NotStopd t0: [18:35:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:35:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg v2: 36 u2: mmHg st: NotStopd t0: [18:35:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 48.3333 u1: mmHg st: NotStopd t0: [18:35:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [18:35:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [18:35:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:35:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [18:35:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:35:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:35:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [17:40:00 07/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 16.5 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 41 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 16.5 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 41 rs: Final st: NotStopd
t0: [18:00:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.6 u1: torr st: NotStopd
t0: [17:40:00 07/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 7.5 u1: mg/dl rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 95 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.2 u1: mEq/L rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 139 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 7.5 u1: mg/dl rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 30 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 95 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.2 u1: mEq/L rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [17:40:00 07/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 139 rs: Final st: NotStopd
t0: [17:40:00 07/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 15.5 u1: % rs: Final st: NotStopd
t0: [19:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [19:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 93 u1: BPM st: NotStopd t0: [19:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 104 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [19:00:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 72.6667 u1: mmHg st: NotStopd t0: [19:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [19:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [19:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [19:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 07/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 47.025 vu: ml t0: [19:00:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 14.7812 vu: ml
t0: [19:00:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.2 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [19:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 500 vu: ml
id: Fentanyl el: 100 cu: CCU cg: RN io: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions am: 2500 du: mcghr rt: IV Drip id: Fentanyl el: 200 cu: CSRU cg: RN io: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions am: 2500 du: mcghr rt: IV Drip id: Midazolam el: 100 cu: CCU cg: RN io: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions am: 50 du: mghr rt: IV Drip
id: .9% Normal Saline el: 1 cu: CCU cg: RN io: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions vo: 250 du: ml rt: Intravenous Push id: .9% Normal Saline el: 1 cu: CCU cg: RN io: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions vo: 50 du: ml rt: Intravenous Push id: .9% Normal Saline el: 2 cu: CSRU cg: RN io: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [20:03:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.23 rs: Final st: NotStopd t0: [20:03:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -2 rs: Final st: NotStopd t0: [20:03:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [20:03:00 07/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 64 u1: mmHg rs: Final st: NotStopd t0: [20:03:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 126 u1: mmHg rs: Final st: NotStopd t0: [20:03:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.23 rs: Final st: NotStopd
t0: [20:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [20:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 07/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 93 u1: BPM st: NotStopd t0: [20:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [20:00:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 62.6667 u1: mmHg st: NotStopd t0: [20:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [20:00:00 07/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Push st: NotStopd t0: [20:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [20:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [20:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 07/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:00:00 07/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.2778 u1: Deg. C st: NotStopd t0: [20:00:00 07/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 95.5 u1: Deg. F st: NotStopd t0: [20:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:03:00 07/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.8 rs: Final st: NotStopd t0: [20:03:00 07/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [20:03:00 07/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.8 rs: Final st: NotStopd t0: [20:03:00 07/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd
t0: [20:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 07/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 49.5 vu: ml t0: [20:00:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 16.5 vu: ml t0: [20:00:00 07/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 120 vu: ml
t0: [20:00:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [20:30:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml t0: [20:30:00 07/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 37.125 vu: ml t0: [20:30:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 8.25 vu: ml t0: [20:30:00 07/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 60 vu: ml
t0: [20:24:00 07/01/2016] id: Blood Products Hematology el: 0 cu: CSRU cg: 3161 v1: Y rs: Final st: NotStopd
t0: [20:00:00 07/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 6.97674 u1: ml/cmH st: NotStopd t0: [20:00:00 07/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [20:00:00 07/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [20:00:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [20:00:00 07/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 07/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 07/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1.7 st: NotStopd t0: [20:00:00 07/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 07/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 07/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [20:00:00 07/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 07/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 07/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 07/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 07/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [20:00:00 07/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8 u1: L/min st: NotStopd t0: [20:00:00 07/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 07/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 07/01/2016] id: Peak Flow el: 0 cu: CSRU cg: RRT u1: L/m st: NotStopd t0: [20:00:00 07/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 48 u1: cmH2O st: NotStopd t0: [20:00:00 07/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [20:00:00 07/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [20:00:00 07/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [20:00:00 07/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 07/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 270 u1: ml/B st: NotStopd t0: [20:00:00 07/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 07/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 07/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 07/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 07/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 07/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 07/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 07/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: Flat in Bed st: NotStopd t0: [20:00:00 07/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Stimul st: NotStopd t0: [20:00:00 07/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 07/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 07/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 07/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 07/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:30:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [20:30:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:30:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:30:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:30:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:30:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 89 u1: BPM st: NotStopd t0: [20:30:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:30:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [20:30:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [20:30:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [20:30:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [20:30:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:30:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [20:30:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [20:30:00 07/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:30:00 07/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.5 u1: Deg. C st: NotStopd t0: [20:30:00 07/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 95.9 u1: Deg. F st: NotStopd t0: [20:30:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 07/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [21:00:00 07/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [21:00:00 07/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: Flat in Bed st: NotStopd t0: [21:00:00 07/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [21:00:00 07/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [21:00:00 07/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 07/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd
t0: [20:00:00 07/01/2016] id: Packed RBC's IV Infusions el: 2 cu: CSRU cg: RN ai: 155 vo: 375 vu: ml nb: 1 t0: [20:30:00 07/01/2016] id: Packed RBC's IV Infusions el: 2 cu: CSRU cg: RN ai: 155 vo: 375 vu: ml nb: 1 t0: [21:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml t0: [21:00:00 07/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 42.075 vu: ml t0: [21:00:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 8.25 vu: ml t0: [21:00:00 07/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 35 vu: ml
t0: [20:30:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.34 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:30:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [21:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [21:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [21:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [21:00:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 59.6667 u1: mmHg st: NotStopd t0: [21:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [21:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [21:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [21:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [21:00:00 07/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [21:00:00 07/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.4444 u1: Deg. C st: NotStopd t0: [21:00:00 07/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 95.8 u1: Deg. F st: NotStopd t0: [21:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 07/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 0 vu: ml
t0: [21:00:00 07/01/2016] tf: [16:00:00 11/01/2016] dt: 5460 id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.34 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
tf: [09:00:00 08/01/2016] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Phenylephrine HCl v1: 60 u1: mg m2: D5W v2: 250 u2: ml tf: [17:00:00 10/01/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Fentanyl Citrate v1: 2500 u1: mcg m2: D5W v2: 250 u2: ml tf: [05:00:00 13/01/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Fentanyl Citrate v1: 2500 u1: mcg m2: Soln. v2: 50 u2: ml tf: [05:00:00 13/01/2016] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Midazolam HCl v1: 50 u1: mg m2: D5W v2: 50 u2: ml tf: [11:00:00 16/01/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Fentanyl Citrate v1: 5000 u1: mcg m2: Soln. v2: 100 u2: ml tf: [10:00:00 17/01/2016] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Midazolam HCl v1: 100 u1: mg m2: D5W v2: 100 u2: ml
t0: [20:00:00 07/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 07/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 07/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 07/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 07/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 07/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 07/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 07/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 07/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [20:00:00 07/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 07/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 07/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 07/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 07/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 07/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 07/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 07/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 07/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 07/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 07/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 07/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 07/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 07/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 07/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 07/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 07/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 07/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Sanguinous st: NotStopd t0: [20:00:00 07/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 07/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 07/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 07/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [21:14:00 07/01/2016] id: Blood Products Hematology el: 0 cu: CSRU cg: 3161 v1: Y rs: Final st: NotStopd
t0: [20:30:00 07/01/2016] id: Procedures el: 0 cu: CSRU cg: RN v1: Line Placement st: NotStopd t0: [21:15:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [21:15:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:15:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:15:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:15:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:15:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [21:15:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:15:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [21:15:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 63.3333 u1: mmHg st: NotStopd t0: [21:15:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [21:15:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [21:15:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:15:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [21:15:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [21:15:00 07/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [21:15:00 07/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 35.3333 u1: Deg. C st: NotStopd t0: [21:15:00 07/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 95.6 u1: Deg. F st: NotStopd t0: [21:15:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 07/01/2016] id: Packed RBC's IV Infusions el: 2 cu: CSRU cg: RN ai: 155 vo: 375 vu: ml nb: 1
t0: [21:15:00 07/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:15:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.34 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:15:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [21:00:00 07/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 0 vu: ml
t0: [21:15:00 07/01/2016] tf: [16:00:00 11/01/2016] dt: 5445 id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [21:58:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 6.99 rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 110 rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.4 rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.7 rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -9 rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 27 rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 71 u1: mmHg rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 6.99 rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 110 rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 0.85 rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.4 rs: Final st: NotStopd t0: [21:58:00 07/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.7 rs: Final st: NotStopd
tf: [08:00:00 08/01/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 25 u1: mg
t0: [22:00:00 07/01/2016] id: Compliance (40-60ml) el: 0 cu: CSRU cg: RRT v1: 6.97674 u1: ml/cmH st: NotStopd t0: [22:00:00 07/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [22:00:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 1 u1: torr st: NotStopd t0: [22:00:00 07/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [22:00:00 07/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [22:00:00 07/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [22:00:00 07/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [22:00:00 07/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 7 u1: L/min st: NotStopd t0: [22:00:00 07/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [22:00:00 07/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 48 u1: cmH2O st: NotStopd t0: [22:00:00 07/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [22:00:00 07/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [22:00:00 07/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [22:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 91 u1: % st: NotStopd t0: [22:00:00 07/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 220 u1: ml/B st: NotStopd t0: [22:00:00 07/01/2016] id: Tidal Volume (Set) el: 0 cu: CSRU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [22:00:00 07/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Assist Control st: NotStopd t0: [22:00:00 07/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [22:00:00 07/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [21:30:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [21:30:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:30:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:30:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:30:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:30:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 65 u1: BPM st: NotStopd t0: [21:30:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:30:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 42 u2: mmHg st: NotStopd t0: [21:30:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [21:30:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 116 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [21:30:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [21:30:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:30:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [21:30:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [21:30:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:45:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [21:45:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:45:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:45:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:45:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:45:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 58 u1: BPM st: NotStopd t0: [21:45:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:45:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg v2: 43 u2: mmHg st: NotStopd t0: [21:45:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 55 u1: mmHg st: NotStopd t0: [21:45:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [21:45:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [21:45:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:45:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [21:45:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 95 u1: % st: NotStopd t0: [21:45:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: Frequent st: NotStopd t0: [22:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: PVC's st: NotStopd t0: [22:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 54 u1: BPM st: NotStopd t0: [22:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 07/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg v2: 43 u2: mmHg st: NotStopd t0: [22:00:00 07/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 55 u1: mmHg st: NotStopd t0: [22:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [22:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [22:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [22:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 07/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 84.15 vu: ml t0: [22:00:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 16.5 vu: ml t0: [22:00:00 07/01/2016] tf: [09:53:00 12/01/2016] dt: 6473 id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 5 vu: ml t0: [22:00:00 07/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 70 vu: ml
t0: [21:30:00 07/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:30:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.34 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:30:00 07/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:30:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.75 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:45:00 07/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:45:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:45:00 07/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:45:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.75 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 07/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 07/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.6 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [22:15:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 1.25 vu: ml t0: [22:15:00 07/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 37.125 vu: ml t0: [22:15:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [22:15:00 07/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 1.25 vu: ml t0: [22:15:00 07/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [21:55:00 07/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.1 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 13.1 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 27.4 u1: % rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 8.9 u1: gm/dl rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 240 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 2.94 u1: /mic l rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.1 rs: Final st: NotStopd
t0: [22:43:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 6.92 rs: Final st: NotStopd t0: [22:43:00 07/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.3 rs: Final st: NotStopd t0: [22:43:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -7 rs: Final st: NotStopd t0: [22:43:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 34 rs: Final st: NotStopd t0: [22:43:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 97 u1: mmHg rs: Final st: NotStopd t0: [22:43:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 6.92 rs: Final st: NotStopd t0: [22:43:00 07/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.28 rs: Final st: NotStopd t0: [22:43:00 07/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.3 rs: Final st: NotStopd
t0: [23:00:00 07/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [23:00:00 07/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [23:00:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [23:00:00 07/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 70 u1: cmH2O st: NotStopd t0: [23:00:00 07/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [23:00:00 07/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [23:00:00 07/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [23:00:00 07/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [23:00:00 07/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [23:00:00 07/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [23:00:00 07/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [23:00:00 07/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.2 u1: L/min st: NotStopd t0: [23:00:00 07/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [23:00:00 07/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [23:00:00 07/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 62 u1: cmH2O st: NotStopd t0: [23:00:00 07/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [23:00:00 07/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [23:00:00 07/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [23:00:00 07/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [23:00:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [23:00:00 07/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [23:00:00 07/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:1.5 st: NotStopd t0: [23:00:00 07/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 48 u1: cmH2O st: NotStopd t0: [23:00:00 07/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.8 u1: sec st: NotStopd t0: [23:00:00 07/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 35 st: NotStopd t0: [23:00:00 07/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 280 u1: ml/B st: NotStopd t0: [23:00:00 07/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [23:00:00 07/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [21:55:00 07/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 19.1 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 2.4 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 47.9 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 2.4 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 19.1 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 47.9 rs: Final st: NotStopd
t0: [23:07:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.07 rs: Final st: NotStopd t0: [23:07:00 07/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.1 rs: Final st: NotStopd t0: [23:07:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -3 rs: Final st: NotStopd t0: [23:07:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 31 rs: Final st: NotStopd t0: [23:07:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 94 u1: mmHg rs: Final st: NotStopd t0: [23:07:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.07 rs: Final st: NotStopd t0: [23:07:00 07/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.1 rs: Final st: NotStopd
t0: [21:55:00 07/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 107 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 116 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 7.1 u1: mEq/L rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.6 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 23 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 107 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 116 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 7.1 u1: mEq/L rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.6 rs: Final st: NotStopd t0: [21:55:00 07/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd
t0: [23:15:00 07/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [23:15:00 07/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [23:15:00 07/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [23:15:00 07/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [23:15:00 07/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [23:15:00 07/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [23:15:00 07/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [23:15:00 07/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [23:15:00 07/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [23:15:00 07/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 67 u1: cmH2O st: NotStopd t0: [23:15:00 07/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [23:15:00 07/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [23:15:00 07/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [23:15:00 07/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [23:15:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [23:15:00 07/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [23:15:00 07/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:1.5 st: NotStopd t0: [23:15:00 07/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 58 u1: cmH2O st: NotStopd t0: [23:15:00 07/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.8 u1: sec st: NotStopd t0: [23:15:00 07/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 34 st: NotStopd t0: [23:15:00 07/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [23:15:00 07/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [23:15:00 07/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [23:15:00 07/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [23:30:00 07/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd
t0: [23:46:00 07/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.27 rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -3 rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 52 u1: mmHg rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 127 u1: mmHg rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.27 rs: Final st: NotStopd
t0: [23:46:00 07/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 11.8427 u1: ml/dl st: NotStopd t0: [23:46:00 07/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 6 rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 138 rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.09 rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 6 rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [23:46:00 07/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 96 u1: % rs: Final st: NotStopd
t0: [00:00:00 08/01/2016] id: INV Line#4 D/C Date el: 0 cu: CSRU cg: -1 st: D/C'd t0: [00:00:00 08/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: -1 st: D/C'd t0: [00:00:00 08/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: -1 st: D/C'd t0: [00:00:00 08/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: -1 st: D/C'd t0: [00:00:00 08/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: -1 st: D/C'd t0: [00:00:00 08/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [20:00:00 07/01/2016] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 07/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 07/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 07/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [20:00:00 07/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [20:00:00 07/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 07/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [20:00:00 07/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 07/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Dampened st: NotStopd t0: [20:00:00 07/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 07/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 07/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 07/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 07/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [20:00:00 07/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 07/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 13 u1: number st: NotStopd t0: [20:00:00 07/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [21:00:00 07/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [21:00:00 07/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 07/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [21:00:00 07/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [21:00:00 07/01/2016] id: INV Line#4 D/C Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [21:00:00 07/01/2016] id: INV Line#4 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Right Radial st: NotStopd t0: [21:00:00 07/01/2016] id: INV Line#4 Zero/Cal el: 0 cu: CSRU cg: RN v1: Discontinued st: NotStopd t0: [21:00:00 07/01/2016] id: INV Line#4InsertDate el: 0 cu: CSRU cg: RN v1: 12 v2: 25 st: NotStopd t0: [21:00:00 07/01/2016] id: INV Line#4SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [21:00:00 07/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 07/01/2016] id: INV#4 WaveformAppear el: 0 cu: CSRU cg: RN v1: Dampened st: NotStopd t0: [21:00:00 07/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [22:00:00 07/01/2016] id: Procedures el: 0 cu: CSRU cg: RN v1: Cardiac Echo st: NotStopd t0: [22:05:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:05:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:05:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:05:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 83 u1: BPM st: NotStopd t0: [22:05:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:05:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [22:05:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [22:05:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:05:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 90 u1: % st: NotStopd t0: [22:05:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:30:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:30:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:30:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:30:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:30:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:30:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 100 u1: BPM st: NotStopd t0: [22:30:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [22:30:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 116 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [22:30:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [22:30:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:30:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 22 u1: BPM st: NotStopd t0: [22:30:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [22:30:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:00:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 07/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 07/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 107 u1: BPM st: NotStopd t0: [23:00:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [23:00:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 113 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [23:00:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [23:00:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 07/01/2016] id: Procedures el: 0 cu: CSRU cg: RN v1: Paracentesis st: NotStopd t0: [23:00:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 19 u1: BPM st: NotStopd t0: [23:00:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 08/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 08/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 08/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [00:00:00 08/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 08/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 08/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 08/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 08/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 08/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 08/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [00:00:00 08/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [00:00:00 08/01/2016] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [00:00:00 08/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [00:00:00 08/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 08/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 08/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 08/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 124 u1: BPM st: NotStopd t0: [00:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [00:00:00 08/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 08/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 08/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 08/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 08/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 08/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Open v2: Pink st: NotStopd t0: [00:00:00 08/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 08/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: Serous v2: Large st: NotStopd t0: [00:00:00 08/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 08/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Changed st: NotStopd t0: [00:00:00 08/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 08/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 08/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 08/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 08/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 08/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [00:00:00 08/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 08/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 131 u1: mmHg v2: 95 u2: mmHg st: NotStopd t0: [00:00:00 08/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [00:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [00:00:00 08/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 08/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 08/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 08/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 3 u1: BPM st: NotStopd t0: [00:00:00 08/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 08/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 08/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 34.7778 u1: Deg. C st: NotStopd t0: [00:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 94.6 u1: Deg. F st: NotStopd t0: [00:00:00 08/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Cloudy st: NotStopd t0: [00:00:00 08/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 08/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 08/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [00:00:00 08/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Sanguinous st: NotStopd t0: [00:00:00 08/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 08/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 08/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 08/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Sanguinous st: NotStopd
t0: [22:45:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 2.5 vu: ml t0: [22:45:00 07/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 74.25 vu: ml t0: [22:45:00 07/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [22:45:00 07/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 2.5 vu: ml t0: [22:45:00 07/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 210 vu: ml
t0: [22:05:00 07/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:05:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.7 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:05:00 07/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:05:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:30:00 07/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:30:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.6 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:30:00 07/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:30:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 07/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.6 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 07/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 0.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.6 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 07/01/2016] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN pv: 290 cv: 1765 ap: none
t0: [23:30:00 07/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:30:00 07/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:30:00 07/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:30:00 07/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 123 u1: BPM st: NotStopd t0: [23:30:00 07/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Atrial Fib st: NotStopd t0: [23:30:00 07/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [23:30:00 07/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [23:30:00 07/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:30:00 07/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [23:30:00 07/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:30:00 07/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 52 u1: cmH2O st: NotStopd t0: [23:30:00 07/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:05:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [00:05:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:05:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:05:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:05:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:05:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 86 u1: BPM st: NotStopd t0: [00:05:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:05:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [00:05:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [00:05:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:05:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 4 u1: BPM st: NotStopd t0: [00:05:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [00:05:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:30:00 07/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:30:00 07/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.6 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:30:00 07/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:30:00 07/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:05:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:05:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:05:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:05:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:30:00 07/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd
t0: [00:00:00 08/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 14 t0: [00:00:00 08/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [00:00:00 08/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.6 u1: torr st: NotStopd t0: [00:00:00 08/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 80 u1: cmH2O st: NotStopd t0: [00:00:00 08/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [00:00:00 08/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 08/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 08/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [00:00:00 08/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 08/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 08/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 08/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 08/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [00:00:00 08/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [00:00:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [00:00:00 08/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 65 u1: cmH2O st: NotStopd t0: [00:00:00 08/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 4 u1: BPM st: NotStopd t0: [00:00:00 08/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [00:00:00 08/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 08/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 08/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [00:00:00 08/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [00:00:00 08/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [00:00:00 08/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [00:00:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 47 u1: cmH2O st: NotStopd t0: [00:00:00 08/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [00:00:00 08/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 29 st: NotStopd t0: [00:00:00 08/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [00:00:00 08/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [00:00:00 08/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [00:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [00:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 92 u1: BPM st: NotStopd t0: [00:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [00:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [00:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [00:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [00:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [01:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 103 u1: BPM st: NotStopd t0: [01:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [01:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [01:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 12 u1: BPM st: NotStopd t0: [01:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [01:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [01:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [01:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 6.25 vu: ml t0: [00:00:00 08/01/2016] id: Packed RBC's IV Infusions el: 2 cu: CSRU cg: RN ai: 155 vo: 375 vu: ml nb: 1 t0: [00:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 185.625 vu: ml t0: [00:00:00 08/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [00:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 6.25 vu: ml t0: [00:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 110 vu: ml t0: [00:30:00 08/01/2016] id: Packed RBC's IV Infusions el: 2 cu: CSRU cg: RN ai: 155 vo: 375 vu: ml nb: 1
t0: [00:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:30:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 08/01/2016] dt: 24 id: Blood Products Total el: 3 cu: CSRU cg: RN pv: 375 cv: 3021 ap: none
t0: [01:15:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [01:15:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:15:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:15:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:15:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:15:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [01:15:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:15:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [01:15:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [01:15:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:15:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 17 u1: BPM st: NotStopd t0: [01:15:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:15:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [01:15:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.0556 u1: Deg. C st: NotStopd t0: [01:15:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.9 u1: Deg. F st: NotStopd t0: [01:15:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:15:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:15:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:15:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:15:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
id: Fresh Frozen Plasma el: 1 cu: CSRU cg: RN io: Fresh Frozen Plasma IV Infusions du: ml rt: Intravenous Push
t0: [02:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [02:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 95 u1: BPM st: NotStopd t0: [02:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 110 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [02:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [02:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [02:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 113.438 vu: ml t0: [01:00:00 08/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [01:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 7.5 vu: ml t0: [01:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 90 vu: ml
t0: [02:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 08/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 0 cv: 0 ap: none t0: [23:00:00 08/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: 398.663 cv: 398.663 ap: none t0: [23:00:00 08/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 23.6625 cv: 3593.93 ap: none t0: [23:00:00 08/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 398.663 cv: 6704.93 ap: none t0: [23:00:00 08/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 0 cv: 65 ap: none t0: [23:00:00 08/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: 398.663 cv: 5779.93 ap: none t0: [23:00:00 08/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 0 cv: 925 ap: none t0: [23:00:00 08/01/2016] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN pv: 0 cv: 610 ap: none
t0: [02:20:00 08/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.3 rs: Final st: NotStopd t0: [02:20:00 08/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -3 rs: Final st: NotStopd t0: [02:20:00 08/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 24 rs: Final st: NotStopd t0: [02:20:00 08/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 46 u1: mmHg rs: Final st: NotStopd t0: [02:20:00 08/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 163 u1: mmHg rs: Final st: NotStopd t0: [02:20:00 08/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.3 rs: Final st: NotStopd
t0: [20:00:00 07/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 07/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 08/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 08/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 08/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 08/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 08/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 08/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 08/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 08/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 08/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [00:00:00 08/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [00:00:00 08/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [02:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [02:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [02:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.6 u1: Deg. F st: NotStopd
t0: [22:00:00 07/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 500 vu: ml t0: [22:00:00 07/01/2016] tf: [18:00:00 09/01/2016] dt: 2640 id: Fresh Frozen Plasma IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 229 vu: ml t0: [23:00:00 07/01/2016] id: Fresh Frozen Plasma IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 323 vu: ml
t0: [23:00:00 07/01/2016] dt: 24 id: Blood Products Total el: 3 cu: CSRU cg: RN pv: 323 cv: 2052 ap: none t0: [23:00:00 08/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: 398.663 cv: 9035.51 ap: carryForward
t0: [02:16:00 08/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 18.1 rs: Final st: NotStopd t0: [02:16:00 08/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 2.2 rs: Final st: NotStopd t0: [02:16:00 08/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 41.3 rs: Final st: NotStopd t0: [02:16:00 08/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 2.2 rs: Final st: NotStopd t0: [02:16:00 08/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 18.1 rs: Final st: NotStopd t0: [02:16:00 08/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 41.3 rs: Final st: NotStopd
t0: [03:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CSRU cg: -1 ai: 107 vo: 0 st: D/C'd
t0: [01:30:00 08/01/2016] id: Fresh Frozen Plasma IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 309 vu: ml nb: 1 t0: [02:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 08/01/2016] id: Fresh Frozen Plasma IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 283 vu: ml nb: 1 t0: [02:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 99 vu: ml t0: [02:00:00 08/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [02:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 7.5 vu: ml
t0: [03:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [03:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 104 u1: BPM st: NotStopd t0: [03:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [03:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [03:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [03:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [03:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 107 u1: BPM st: NotStopd t0: [03:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 109 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [03:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [03:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [03:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:30:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [03:30:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [03:30:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [03:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:45:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [03:45:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:45:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:45:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:45:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:45:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 108 u1: BPM st: NotStopd t0: [03:45:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:45:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 123 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [03:45:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [03:45:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:45:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [03:45:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:45:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [03:45:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [03:45:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [03:45:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.4 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:30:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:45:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:45:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:45:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:45:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:00:00 08/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 14 t0: [04:00:00 08/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [04:00:00 08/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [04:00:00 08/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 80 u1: cmH2O st: NotStopd t0: [04:00:00 08/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [04:00:00 08/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 08/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 08/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [04:00:00 08/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 08/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 08/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 08/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 08/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [04:00:00 08/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [04:00:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [04:00:00 08/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 65 u1: cmH2O st: NotStopd t0: [04:00:00 08/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 08/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 08/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 08/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 08/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [04:00:00 08/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [04:00:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 47 u1: cmH2O st: NotStopd t0: [04:00:00 08/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [04:00:00 08/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 29 st: NotStopd t0: [04:00:00 08/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [04:00:00 08/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [04:00:00 08/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [04:16:00 08/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.3 rs: Final st: NotStopd t0: [04:16:00 08/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: -1 rs: Final st: NotStopd t0: [04:16:00 08/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [04:16:00 08/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 51 u1: mmHg rs: Final st: NotStopd t0: [04:16:00 08/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 112 u1: mmHg rs: Final st: NotStopd t0: [04:16:00 08/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.3 rs: Final st: NotStopd
t0: [04:16:00 08/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.5 rs: Final st: NotStopd t0: [04:16:00 08/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.08 rs: Final st: NotStopd t0: [04:16:00 08/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.5 rs: Final st: NotStopd
t0: [20:00:00 07/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 07/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 07/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 07/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 07/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 07/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 07/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 07/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 07/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 07/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [22:00:00 07/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [22:00:00 07/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 07/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 07/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 07/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 07/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [22:00:00 07/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 07/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 07/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 07/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 08/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 08/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 08/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 08/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [00:00:00 08/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 08/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 08/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 08/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 08/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 08/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 08/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [02:00:00 08/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [02:00:00 08/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 08/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [02:00:00 08/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 08/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [02:00:00 08/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 08/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 08/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [03:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 08/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 08/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 08/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 08/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 08/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [04:00:00 08/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 08/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 08/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 08/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [04:00:00 08/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 08/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [04:00:00 08/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 08/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 08/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Activity st: NotStopd t0: [04:00:00 08/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [04:00:00 08/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [04:00:00 08/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 08/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 08/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 08/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 110 u1: BPM st: NotStopd t0: [04:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [04:00:00 08/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 08/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 08/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 08/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 08/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 08/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 08/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [04:00:00 08/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 08/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 08/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 08/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 08/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 08/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 08/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 08/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: Serous v2: Large st: NotStopd t0: [04:00:00 08/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 08/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 08/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 08/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 08/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 08/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [04:00:00 08/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 08/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 116 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [04:00:00 08/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [04:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [04:00:00 08/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 08/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 08/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 08/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 08/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [04:00:00 08/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 08/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 08/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 08/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 08/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 08/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [04:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [04:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [04:00:00 08/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 08/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 08/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [04:00:00 08/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 08/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 08/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 08/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [04:00:00 08/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 08/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 13 u1: number st: NotStopd t0: [04:00:00 08/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 08/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [04:00:00 08/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 08/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 08/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 08/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [04:19:00 08/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 19.4 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 19.4 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 30.5 u1: % rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.5 u1: gm/dl rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 242 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.43 u1: /mic l rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 19.4 rs: Final st: NotStopd
t0: [01:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 1000 vu: ml t0: [02:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 100 vu: ml t0: [03:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 99 vu: ml t0: [03:00:00 08/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [03:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 7.5 vu: ml t0: [04:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 92.8125 vu: ml t0: [04:00:00 08/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [04:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 7.5 vu: ml t0: [04:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 80 vu: ml
t0: [04:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:19:00 08/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 16.1 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Fibrinogen Coags el: 0 cu: CSRU cg: 3161 v1: 225 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 35.9 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Fibrinogen (150-400) Coags el: 0 cu: CSRU cg: 3161 v1: 225 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 16.1 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 35.9 rs: Final st: NotStopd
t0: [04:45:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [04:45:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:45:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:45:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 110 u1: BPM st: NotStopd t0: [04:45:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 115 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [04:45:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [04:45:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:45:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [04:45:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [04:45:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [05:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 112 u1: BPM st: NotStopd t0: [05:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [05:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [05:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [05:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 74.25 vu: ml t0: [05:00:00 08/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [05:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [05:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [04:45:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:45:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.26 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:45:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:45:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.24 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:19:00 08/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 123 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 6.2 u1: mEq/L rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.2 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 123 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 6.2 u1: mEq/L rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.2 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd
t0: [05:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [05:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 111 u1: BPM st: NotStopd t0: [05:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [05:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 112 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [05:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [05:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [05:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [05:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.22 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:30:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
tf: [21:00:00 26/02/2016] pt: Unit Dose rt: IV fr: PRN m1: Calcium Gluconate v1: 2 u1: gm
t0: [04:19:00 08/01/2016] id: Albumin Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.2 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Total Bili Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.7 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Total Protein Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.7 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: ALT Enzymes el: 0 cu: CSRU cg: 3161 v1: 27 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: AST Enzymes el: 0 cu: CSRU cg: 3161 v1: 115 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Albumin (>3.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.2 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Alk. Phosphate Enzymes el: 0 cu: CSRU cg: 3161 v1: 61 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.7 rs: Final st: NotStopd t0: [04:19:00 08/01/2016] id: Total Protein(6.5-8) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.7 rs: Final st: NotStopd
t0: [06:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [06:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 105 u1: BPM st: NotStopd t0: [06:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [06:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 54 u1: mmHg st: NotStopd t0: [06:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 5 u1: BPM st: NotStopd t0: [06:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 85 u1: % st: NotStopd t0: [06:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [06:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [06:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [06:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:45:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [06:45:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:45:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:45:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:45:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:45:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 99 u1: BPM st: NotStopd t0: [06:45:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Sinus Tachy st: NotStopd t0: [06:45:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [06:45:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [06:45:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:45:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [06:45:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:45:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Blood st: NotStopd t0: [06:45:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [06:45:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [06:45:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 08/01/2016] id: Packed RBC's IV Infusions el: 2 cu: CSRU cg: RN ai: 155 vo: 375 vu: ml nb: 1 t0: [06:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 56.925 vu: ml t0: [06:00:00 08/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [06:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [06:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [05:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.12 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:45:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:45:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.08 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:45:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:45:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [07:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [07:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 90 u1: BPM st: NotStopd t0: [07:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [07:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [07:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [07:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 27.225 vu: ml t0: [07:00:00 08/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [07:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [07:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [07:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
tf: [06:00:00 09/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 7 dn: 1 m1: Magnesium Sulfate v1: 1 u1: gm
t0: [07:00:00 08/01/2016] id: Fresh Frozen Plasma IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 290 vu: ml nb: 1
t0: [07:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [07:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [07:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.2 u1: Deg. F st: NotStopd
t0: [07:15:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [07:15:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:15:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:15:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:15:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:15:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 84 u1: BPM st: NotStopd t0: [07:15:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:15:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [07:15:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [07:15:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:15:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [07:15:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:15:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [07:15:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2778 u1: Deg. C st: NotStopd t0: [07:15:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.3 u1: Deg. F st: NotStopd t0: [07:15:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [07:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 84 u1: BPM st: NotStopd t0: [07:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [07:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [07:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [07:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [07:30:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [07:30:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [07:30:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [07:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:15:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:15:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:15:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [07:15:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [07:30:00 08/01/2016] id: Neosynephrine-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [07:00:00 08/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 14 t0: [07:00:00 08/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [07:00:00 08/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [07:00:00 08/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 80 u1: cmH2O st: NotStopd t0: [07:00:00 08/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [07:00:00 08/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [07:00:00 08/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [07:00:00 08/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.9 u1: Deg. C st: NotStopd t0: [07:00:00 08/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:00:00 08/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 9 st: NotStopd t0: [07:00:00 08/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:00:00 08/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:00:00 08/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [07:00:00 08/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [07:00:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [07:00:00 08/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [07:00:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 65 u1: cmH2O st: NotStopd t0: [07:00:00 08/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [07:00:00 08/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [07:00:00 08/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [07:00:00 08/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [07:00:00 08/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [07:00:00 08/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [07:00:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 47 u1: cmH2O st: NotStopd t0: [07:00:00 08/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [07:00:00 08/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 28 st: NotStopd t0: [07:00:00 08/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 375 u1: ml/B st: NotStopd t0: [07:00:00 08/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [07:00:00 08/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [07:00:00 08/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [07:30:00 08/01/2016] id: Radiologic Study el: 0 cu: CSRU cg: RN v1: Chest Xray st: NotStopd
t0: [07:46:00 08/01/2016] id: Blood Products Hematology el: 0 cu: CSRU cg: 3161 v1: Y rs: Final st: NotStopd
t0: [08:00:00 08/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 08/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 08/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 08/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 08/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 08/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 08/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [08:00:00 08/01/2016] id: PainLevel Acceptable el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [08:00:00 08/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 08/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 08/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 08/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [08:00:00 08/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 08/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [08:00:00 08/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 08/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 08/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 08/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 08/01/2016] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 08/01/2016] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient/Family st: NotStopd t0: [08:00:00 08/01/2016] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [08:00:00 08/01/2016] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 08/01/2016] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [08:00:00 08/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 08/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [08:00:00 08/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [08:00:00 08/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 08/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 08/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 08/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 08/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 08/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [08:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 78 u1: BPM st: NotStopd t0: [08:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 08/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 08/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 08/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 08/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 08/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 08/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 08/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [08:00:00 08/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Pink st: NotStopd t0: [08:00:00 08/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 08/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 08/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 08/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: Serous v2: Small st: NotStopd t0: [08:00:00 08/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 08/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 08/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 08/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 08/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 08/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [08:00:00 08/01/2016] id: Nursing Consultation el: 0 cu: CSRU cg: RN v1: Resp Therapy st: NotStopd t0: [08:00:00 08/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 08/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 08/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [08:00:00 08/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [08:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [08:00:00 08/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 08/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 08/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 08/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 08/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [08:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [08:00:00 08/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 08/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 08/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 08/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 08/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 08/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 08/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 08/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 08/01/2016] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [08:00:00 08/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.3889 u1: Deg. C st: NotStopd t0: [08:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.5 u1: Deg. F st: NotStopd t0: [08:00:00 08/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 08/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 08/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 08/01/2016] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.10265 u1: m2 st: NotStopd t0: [08:00:00 08/01/2016] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.29011 u1: m2 st: NotStopd t0: [08:00:00 08/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 08/01/2016] id: Weight Change el: 0 cu: CSRU cg: RN v1: 0 u1: kg st: NotStopd t0: [08:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 08/01/2016] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [08:00:00 08/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [08:00:00 08/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 08/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 08/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 08/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 08/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 08/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 08/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 08/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 08/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 08/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 08/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 08/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [08:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 12.375 vu: ml t0: [08:00:00 08/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 0 vu: ml t0: [08:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml
t0: [08:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:29:00 08/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.47 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.2412 u1: ml/dl st: NotStopd t0: [08:29:00 08/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 109 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.9 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.1 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 2 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 34 u1: mmHg rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 146 u1: mmHg rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.47 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 109 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.12 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.9 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.1 rs: Final st: NotStopd t0: [08:29:00 08/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [08:30:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [08:30:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 60 u1: cmH2O st: NotStopd t0: [08:30:00 08/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [08:30:00 08/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:30:00 08/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:30:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 42 u1: cmH2O st: NotStopd t0: [08:30:00 08/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 409 u1: ml/B st: NotStopd
t0: [09:00:00 08/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.44 u1: L/min st: NotStopd t0: [09:00:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [09:00:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [09:00:00 08/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [09:00:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [09:00:00 08/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 330 u1: ml/B st: NotStopd
t0: [09:05:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [09:05:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 53 u1: cmH2O st: NotStopd t0: [09:05:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [09:05:00 08/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 305 u1: ml/B st: NotStopd
t0: [09:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [09:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [09:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 77 u1: BPM st: NotStopd t0: [09:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [09:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [09:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [09:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [09:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 9.9 vu: ml t0: [09:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml
t0: [09:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [09:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [09:52:00 08/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd t0: [09:52:00 08/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.054 u1: ml/dl st: NotStopd t0: [09:52:00 08/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 1 rs: Final st: NotStopd t0: [09:52:00 08/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 29 rs: Final st: NotStopd t0: [09:52:00 08/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 50 u1: mmHg rs: Final st: NotStopd t0: [09:52:00 08/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 131 u1: mmHg rs: Final st: NotStopd t0: [09:52:00 08/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.35 rs: Final st: NotStopd t0: [09:52:00 08/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 97 u1: % rs: Final st: NotStopd
t0: [10:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [10:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [10:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 82 u1: BPM st: NotStopd t0: [10:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [10:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [10:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [10:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [10:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:15:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [10:15:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:15:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:15:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 85 u1: BPM st: NotStopd t0: [10:15:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [10:15:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [10:15:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:15:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [10:15:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:15:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 9.9 vu: ml t0: [10:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml
t0: [10:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:15:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:15:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:15:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:30:00 08/01/2016] id: Cuff Pressure-Airway el: 0 cu: CSRU cg: RRT u1: cmH2O st: NotStopd t0: [10:30:00 08/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [10:30:00 08/01/2016] id: ETT Position Change el: 0 cu: CSRU cg: RRT v1: Done st: NotStopd t0: [10:30:00 08/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [10:30:00 08/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [10:30:00 08/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [10:30:00 08/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [10:30:00 08/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [10:30:00 08/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [10:30:00 08/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd
t0: [10:30:00 08/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 14 t0: [10:30:00 08/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 80 u1: cmH2O st: NotStopd t0: [10:30:00 08/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [10:30:00 08/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [10:30:00 08/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [10:30:00 08/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 9 st: NotStopd t0: [10:30:00 08/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [10:30:00 08/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.4 u1: L/min st: NotStopd t0: [10:30:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [10:30:00 08/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [10:30:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [10:30:00 08/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [10:30:00 08/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [10:30:00 08/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [10:30:00 08/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [10:30:00 08/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [10:30:00 08/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [10:30:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [10:30:00 08/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [10:30:00 08/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 30 st: NotStopd t0: [10:30:00 08/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [10:30:00 08/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [10:30:00 08/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [10:30:00 08/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [10:45:00 08/01/2016] id: Blood Products Hematology el: 0 cu: CSRU cg: 3161 v1: Y rs: Final st: NotStopd
t0: [10:15:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:15:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:15:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:15:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [10:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [10:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 85 u1: BPM st: NotStopd t0: [10:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [10:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [10:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:30:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [10:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 36 u1: BPM st: NotStopd t0: [10:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:45:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [10:45:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:45:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:45:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:45:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:45:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 83 u1: BPM st: NotStopd t0: [10:45:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:45:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [10:45:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [10:45:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:45:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [10:45:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 41 u1: BPM st: NotStopd t0: [10:45:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:45:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 13.6125 vu: ml t0: [11:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [11:00:00 08/01/2016] tf: [20:00:00 08/01/2016] dt: 540 id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 40 vu: ml
t0: [10:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:45:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:45:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:45:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [11:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [11:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 87 u1: BPM st: NotStopd t0: [11:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [11:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [11:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [11:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 43 u1: BPM st: NotStopd t0: [11:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:45:00 08/01/2016] id: Previous Weight el: 0 cu: CSRU cg: 3161 v1: 65.7 u1: kg st: NotStopd t0: [11:22:00 08/01/2016] id: Blood Products Hematology el: 0 cu: CSRU cg: 3161 v1: Y rs: Final st: NotStopd
t0: [11:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [11:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 87 u1: BPM st: NotStopd t0: [11:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [11:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [11:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:30:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [11:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 43 u1: BPM st: NotStopd t0: [11:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [11:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 17.325 vu: ml t0: [12:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml
t0: [11:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.08 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:49:00 08/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 109 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 3 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 30 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 115 u1: mmHg rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 109 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.17 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [11:45:00 08/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 16 t0: [11:45:00 08/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [11:45:00 08/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [11:45:00 08/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 80 u1: cmH2O st: NotStopd t0: [11:45:00 08/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [11:45:00 08/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [11:45:00 08/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [11:45:00 08/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.7 u1: Deg. C st: NotStopd t0: [11:45:00 08/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:45:00 08/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 9 st: NotStopd t0: [11:45:00 08/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [11:45:00 08/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 14.2 u1: L/min st: NotStopd t0: [11:45:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [11:45:00 08/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [11:45:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 60 u1: cmH2O st: NotStopd t0: [11:45:00 08/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [11:45:00 08/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [11:45:00 08/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [11:45:00 08/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [11:45:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [11:45:00 08/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [11:45:00 08/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [11:45:00 08/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [11:45:00 08/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 32 st: NotStopd t0: [11:45:00 08/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 315 u1: ml/B st: NotStopd t0: [11:45:00 08/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [11:45:00 08/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [11:45:00 08/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [11:45:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd
t0: [11:45:00 08/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 12.9 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 12.9 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 30.5 u1: % rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.6 u1: gm/dl rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 199 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.51 u1: /mic l rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 12.9 rs: Final st: NotStopd t0: [11:49:00 08/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.2764 u1: ml/dl st: NotStopd
t0: [11:45:00 08/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 15 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Fibrinogen Coags el: 0 cu: CSRU cg: 3161 v1: 290.7 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 33.3 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Fibrinogen (150-400) Coags el: 0 cu: CSRU cg: 3161 v1: 290.7 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 15 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 33.3 rs: Final st: NotStopd
t0: [13:00:00 08/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [13:00:00 08/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [13:00:00 08/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [13:00:00 08/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 8.99 u1: L/min st: NotStopd t0: [13:00:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [13:00:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [13:00:00 08/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [13:00:00 08/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [13:00:00 08/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [13:00:00 08/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [13:00:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [13:00:00 08/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [13:00:00 08/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd
t0: [13:00:00 08/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 16 t0: [13:00:00 08/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 70 u1: cmH2O st: NotStopd t0: [13:00:00 08/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [13:00:00 08/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 6.5 st: NotStopd t0: [13:00:00 08/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd
t0: [11:45:00 08/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 32 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 103 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.2 u1: mEq/L rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 140 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 32 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 103 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.7 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.2 u1: mEq/L rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.4 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 140 rs: Final st: NotStopd
t0: [12:00:00 08/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [12:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 08/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [12:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 08/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 08/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [12:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [12:00:00 08/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [12:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [12:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [12:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 44 u1: BPM st: NotStopd t0: [12:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 08/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [13:00:00 08/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [13:00:00 08/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [13:00:00 08/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [13:00:00 08/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [13:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [13:00:00 08/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [13:00:00 08/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [13:00:00 08/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [13:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [13:00:00 08/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [13:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 08/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [13:00:00 08/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [13:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 08/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [13:00:00 08/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 2 To pain st: NotStopd t0: [13:00:00 08/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 4 u1: points st: NotStopd t0: [13:00:00 08/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [13:00:00 08/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Not Done st: NotStopd t0: [13:00:00 08/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Clamped st: NotStopd t0: [13:00:00 08/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [13:00:00 08/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [13:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 86 u1: BPM st: NotStopd t0: [13:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 08/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 08/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [13:00:00 08/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [13:00:00 08/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Pink st: NotStopd t0: [13:00:00 08/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [13:00:00 08/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [13:00:00 08/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 08/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: Serous v2: Small st: NotStopd t0: [13:00:00 08/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 08/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [13:00:00 08/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [13:00:00 08/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [13:00:00 08/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [13:00:00 08/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [13:00:00 08/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [13:00:00 08/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [13:00:00 08/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [13:00:00 08/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [13:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [13:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [13:00:00 08/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [13:00:00 08/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [13:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [13:00:00 08/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [13:00:00 08/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [13:00:00 08/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [13:00:00 08/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [13:00:00 08/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [13:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 21 u1: BPM st: NotStopd t0: [13:00:00 08/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [13:00:00 08/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [13:00:00 08/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [13:00:00 08/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [13:00:00 08/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [13:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 08/01/2016] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [13:00:00 08/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [13:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [13:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [13:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [13:00:00 08/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [13:00:00 08/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [13:00:00 08/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [13:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 08/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [13:00:00 08/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [13:00:00 08/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [13:00:00 08/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [13:00:00 08/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [13:00:00 08/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [13:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 19.8 vu: ml t0: [13:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml
t0: [12:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.08 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [13:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [13:25:00 08/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.36 rs: Final st: NotStopd t0: [13:25:00 08/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 13.7604 u1: ml/dl st: NotStopd t0: [13:25:00 08/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [13:25:00 08/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [13:25:00 08/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 48 u1: mmHg rs: Final st: NotStopd t0: [13:25:00 08/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 86 u1: mmHg rs: Final st: NotStopd t0: [13:25:00 08/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.36 rs: Final st: NotStopd t0: [13:25:00 08/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 95 u1: % rs: Final st: NotStopd
t0: [12:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 85 u1: BPM st: NotStopd t0: [12:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [12:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [12:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:30:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [12:30:00 08/01/2016] id: Radiologic Study el: 0 cu: CSRU cg: RN v1: Chest Xray st: NotStopd t0: [12:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 0 u1: BPM st: NotStopd t0: [12:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [12:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.08 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [13:45:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [13:45:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:45:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [13:45:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:45:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:45:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:45:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 86 u1: BPM st: NotStopd t0: [13:45:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:45:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [13:45:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [13:45:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:45:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [13:45:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [13:45:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [13:45:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:45:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:45:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.08 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:45:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 22 u1: mmHg st: NotStopd t0: [11:30:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [12:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [12:30:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [13:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [13:45:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd
t0: [11:45:00 08/01/2016] id: D-Dimer Coags el: 0 cu: CSRU cg: 3161 v1: 3847 rs: Final st: NotStopd t0: [11:45:00 08/01/2016] id: D-Dimer (0-500) Coags el: 0 cu: CSRU cg: 3161 v1: 3847 rs: Final st: NotStopd
t0: [14:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [14:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [14:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [14:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 89 u1: BPM st: NotStopd t0: [14:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [14:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [14:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [14:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 11 u1: BPM st: NotStopd t0: [14:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [14:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:30:00 08/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 90 vu: ml t0: [14:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 16.0875 vu: ml t0: [14:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [14:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 40 vu: ml
t0: [14:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.08 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 08/01/2016] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 90 ap: none
t0: [12:00:00 08/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 08/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 08/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [14:30:00 08/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [14:30:00 08/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [14:30:00 08/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:30:00 08/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [14:30:00 08/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [14:30:00 08/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [14:30:00 08/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [14:30:00 08/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:30:00 08/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [14:30:00 08/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [14:30:00 08/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [14:30:00 08/01/2016] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd
t0: [14:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [14:30:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [14:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:30:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [14:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 89 u1: BPM st: NotStopd t0: [14:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [14:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [14:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:30:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [14:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 18 u1: BPM st: NotStopd t0: [14:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [14:30:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [14:30:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [14:30:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [14:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [09:00:00 08/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 08/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 08/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 08/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 08/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [09:00:00 08/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 08/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [12:00:00 08/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 08/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 08/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 08/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 08/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [12:00:00 08/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 08/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [13:00:00 08/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 08/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 08/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 08/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 08/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [13:00:00 08/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:00:00 08/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [14:00:00 08/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 08/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd
t0: [15:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 17.325 vu: ml t0: [15:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml
t0: [15:00:00 08/01/2016] id: Fresh Frozen Plasma IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 308 vu: ml nb: 1
t0: [15:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [15:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [15:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 86 u1: BPM st: NotStopd t0: [15:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [15:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [15:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [15:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [15:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [15:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.06 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:30:00 08/01/2016] id: Fresh Frozen Plasma IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 331 vu: ml nb: 1
t0: [15:45:00 08/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.28 rs: Final st: NotStopd t0: [15:45:00 08/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [15:45:00 08/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [15:45:00 08/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [15:45:00 08/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 31 rs: Final st: NotStopd t0: [15:45:00 08/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 63 u1: mmHg rs: Final st: NotStopd t0: [15:45:00 08/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 64 u1: mmHg rs: Final st: NotStopd t0: [15:45:00 08/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.28 rs: Final st: NotStopd t0: [15:45:00 08/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.04 rs: Final st: NotStopd t0: [15:45:00 08/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.6 rs: Final st: NotStopd t0: [15:45:00 08/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd
t0: [15:30:00 08/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 16 t0: [15:30:00 08/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [15:30:00 08/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [15:30:00 08/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 70 u1: cmH2O st: NotStopd t0: [15:30:00 08/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [15:30:00 08/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [15:30:00 08/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [15:30:00 08/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [15:30:00 08/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 33.9 u1: Deg. C st: NotStopd t0: [15:30:00 08/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [15:30:00 08/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 6.5 st: NotStopd t0: [15:30:00 08/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 8 v2: Combivent st: NotStopd t0: [15:30:00 08/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [15:30:00 08/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.9 u1: L/min st: NotStopd t0: [15:30:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [15:30:00 08/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [15:30:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [15:30:00 08/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [15:30:00 08/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [15:30:00 08/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [15:30:00 08/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [15:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 91 u1: % st: NotStopd t0: [15:30:00 08/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [15:30:00 08/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [15:30:00 08/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [15:30:00 08/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [15:30:00 08/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [15:30:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd
t0: [15:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:30:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 30 u1: mmHg st: NotStopd t0: [15:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 85 u1: BPM st: NotStopd t0: [15:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [15:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:30:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [15:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [16:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 25 u1: mmHg st: NotStopd t0: [16:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 08/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [16:00:00 08/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 88 u1: BPM st: NotStopd t0: [16:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 113 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [16:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [16:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [16:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [16:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 300 vu: ml t0: [16:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 14.85 vu: ml t0: [16:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml
t0: [15:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [16:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [16:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [16:30:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [16:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:30:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [16:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 81 u1: BPM st: NotStopd t0: [16:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [16:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [16:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:30:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [16:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [16:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [16:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [17:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 14.85 vu: ml t0: [17:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml
t0: [17:03:00 08/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.4 rs: Final st: NotStopd t0: [17:03:00 08/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 14.1561 u1: ml/dl st: NotStopd t0: [17:03:00 08/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 2 rs: Final st: NotStopd t0: [17:03:00 08/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 29 rs: Final st: NotStopd t0: [17:03:00 08/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [17:03:00 08/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 122 u1: mmHg rs: Final st: NotStopd t0: [17:03:00 08/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.4 rs: Final st: NotStopd t0: [17:03:00 08/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 97 u1: % rs: Final st: NotStopd
t0: [17:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [17:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [17:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [17:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 77 u1: BPM st: NotStopd t0: [17:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [17:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [17:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [17:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [17:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [17:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 08/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 08/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 08/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 08/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 08/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [15:00:00 08/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 08/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [15:00:00 08/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [15:00:00 08/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 08/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [16:00:00 08/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [16:00:00 08/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 08/01/2016] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd
t0: [17:30:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [17:30:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 46 u1: cmH2O st: NotStopd t0: [17:30:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd
t0: [16:50:00 08/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.4 rs: Final st: NotStopd t0: [16:50:00 08/01/2016] id: Fibrinogen Coags el: 0 cu: CSRU cg: 3161 v1: 300 rs: Final st: NotStopd t0: [16:50:00 08/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [16:50:00 08/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 31.2 rs: Final st: NotStopd t0: [16:50:00 08/01/2016] id: Fibrinogen (150-400) Coags el: 0 cu: CSRU cg: 3161 v1: 300 rs: Final st: NotStopd t0: [16:50:00 08/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [16:50:00 08/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.4 rs: Final st: NotStopd t0: [16:50:00 08/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 31.2 rs: Final st: NotStopd
t0: [15:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [17:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [17:30:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [17:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:30:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [17:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [17:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [17:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [17:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:30:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [17:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [17:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [17:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 4.95 vu: ml t0: [18:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml
t0: [15:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 30 vu: ml
t0: [18:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [18:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [18:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [18:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [18:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [18:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [18:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [18:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [18:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [18:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [18:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [18:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 08/01/2016] tf: [09:53:00 12/01/2016] dt: 5273 id: Gastric Nasogastric el: 1 cu: CSRU cg: RN vo: 250 vu: ml
t0: [18:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 08/01/2016] dt: 24 id: Gastric Out Total el: 3 cu: CSRU cg: RN cv: 250 ap: none
t0: [16:50:00 08/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 29.1 u1: % rs: Final st: NotStopd
t0: [19:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [19:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [19:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [19:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 78 u1: BPM st: NotStopd t0: [19:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [19:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [19:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [19:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [19:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 4.95 vu: ml t0: [19:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml
t0: [19:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [19:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [19:00:00 08/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 16 t0: [19:00:00 08/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [19:00:00 08/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [19:00:00 08/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 70 u1: cmH2O st: NotStopd t0: [19:00:00 08/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [19:00:00 08/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 3 st: NotStopd t0: [19:00:00 08/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [19:00:00 08/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [19:00:00 08/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [19:00:00 08/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [19:00:00 08/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 6.5 st: NotStopd t0: [19:00:00 08/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [19:00:00 08/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [19:00:00 08/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [19:00:00 08/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [19:00:00 08/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [19:00:00 08/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 48 u1: cmH2O st: NotStopd t0: [19:00:00 08/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [19:00:00 08/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [19:00:00 08/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [19:00:00 08/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [19:00:00 08/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [19:00:00 08/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [19:00:00 08/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [19:00:00 08/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [19:00:00 08/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [19:00:00 08/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [19:00:00 08/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [19:00:00 08/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 08/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 08/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 08/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 08/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [20:00:00 08/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 08/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [20:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [20:00:00 08/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 08/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 08/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 08/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [20:00:00 08/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 08/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 08/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 08/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 08/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 08/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 08/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 08/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 08/01/2016] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 08/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Inconsistently st: NotStopd t0: [20:00:00 08/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 7 u1: points st: NotStopd t0: [20:00:00 08/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 08/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 08/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 08/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 08/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 08/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 08/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 08/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 08/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 08/01/2016] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 08/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 08/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [20:00:00 08/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 08/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 08/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 08/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Red st: NotStopd t0: [20:00:00 08/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 08/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 08/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: Serous v2: Small st: NotStopd t0: [20:00:00 08/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 08/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [20:00:00 08/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 08/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 08/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 08/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 08/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 08/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 08/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 08/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 08/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [20:00:00 08/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [20:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [20:00:00 08/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [20:00:00 08/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 08/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 08/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [20:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 08/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 08/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 08/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [20:00:00 08/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 08/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 08/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 08/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 08/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [20:00:00 08/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 08/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 08/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 08/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 08/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [20:00:00 08/01/2016] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 08/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [20:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [20:00:00 08/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [20:00:00 08/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 08/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 08/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 08/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [20:00:00 08/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 08/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 08/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 08/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [20:00:00 08/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 08/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 13 u1: number st: NotStopd t0: [20:00:00 08/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 08/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 08/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 08/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 08/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 08/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [20:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 4.95 vu: ml t0: [20:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [20:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [20:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [20:30:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [20:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 77 u1: BPM st: NotStopd t0: [20:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [20:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [20:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:30:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [20:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [20:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [20:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [21:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [21:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [21:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [21:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 80 u1: BPM st: NotStopd t0: [21:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [21:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [21:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [21:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [21:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 6.1875 vu: ml t0: [21:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [21:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [21:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [22:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 08/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 80 u1: BPM st: NotStopd t0: [22:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [22:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [22:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [22:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 16 u1: BPM st: NotStopd t0: [22:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 7.425 vu: ml t0: [22:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [22:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [22:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 08/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 08/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 08/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 08/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 08/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [22:00:00 08/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 08/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [22:00:00 08/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd
t0: [22:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:30:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [22:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 82 u1: BPM st: NotStopd t0: [22:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [22:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [22:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:30:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [22:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [22:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [22:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:00:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [23:00:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 85 u1: BPM st: NotStopd t0: [23:00:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [23:00:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [23:00:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [23:00:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [23:00:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [23:00:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [23:00:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [23:00:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 08/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 08/01/2016] id: Packed RBC's IV Infusions el: 2 cu: CSRU cg: RN ai: 155 vo: 375 vu: ml nb: 1 t0: [23:00:00 08/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 8.6625 vu: ml t0: [23:00:00 08/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [23:00:00 08/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [23:00:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:15:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:15:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [23:15:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:15:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:15:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:15:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:15:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 86 u1: BPM st: NotStopd t0: [23:15:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:15:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [23:15:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [23:15:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:15:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [23:15:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [23:15:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:15:00 08/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [23:15:00 08/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [23:15:00 08/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [23:15:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:15:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:15:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:15:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:30:00 08/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:30:00 08/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [23:30:00 08/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:30:00 08/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:30:00 08/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:30:00 08/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:30:00 08/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 85 u1: BPM st: NotStopd t0: [23:30:00 08/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:30:00 08/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [23:30:00 08/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [23:30:00 08/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:30:00 08/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [23:30:00 08/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [23:30:00 08/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:30:00 08/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:30:00 08/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:30:00 08/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:30:00 08/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 09/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 09/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 09/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 09/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [00:00:00 09/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 09/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [00:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [00:00:00 09/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 09/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 09/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 09/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 09/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [00:00:00 09/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 09/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 09/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 09/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 09/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 09/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 09/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [00:00:00 09/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 2 To pain st: NotStopd t0: [00:00:00 09/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Inconsistently st: NotStopd t0: [00:00:00 09/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 7 u1: points st: NotStopd t0: [00:00:00 09/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 09/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 09/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 09/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 09/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 84 u1: BPM st: NotStopd t0: [00:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 09/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 09/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [00:00:00 09/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 09/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 09/01/2016] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 09/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 09/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 09/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [00:00:00 09/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 09/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 09/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Red st: NotStopd t0: [00:00:00 09/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 09/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 09/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: Serous v2: Moderate st: NotStopd t0: [00:00:00 09/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 09/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 09/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 09/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 09/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 09/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 09/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Stimul st: NotStopd t0: [00:00:00 09/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [00:00:00 09/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 09/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 09/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [00:00:00 09/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [00:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [00:00:00 09/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [00:00:00 09/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 09/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 09/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [00:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 09/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [00:00:00 09/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 09/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [00:00:00 09/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 09/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 09/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 09/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 09/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [00:00:00 09/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 09/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 09/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 09/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 09/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 09/01/2016] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 09/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 09/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [00:00:00 09/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [00:00:00 09/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [00:00:00 09/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [00:00:00 09/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 09/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 09/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 09/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [00:00:00 09/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [00:00:00 09/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 09/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 09/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 09/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [00:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 09/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 9.9 vu: ml t0: [00:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [00:00:00 09/01/2016] tf: [01:00:00 09/01/2016] dt: 60 id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 20 vu: ml
t0: [00:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 09/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 11 t0: [00:00:00 09/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [00:00:00 09/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [00:00:00 09/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 60 u1: cmH2O st: NotStopd t0: [00:00:00 09/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 09/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 3 st: NotStopd t0: [00:00:00 09/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 09/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 09/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [00:00:00 09/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 09/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 6.5 st: NotStopd t0: [00:00:00 09/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [00:00:00 09/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [00:00:00 09/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9 u1: L/min st: NotStopd t0: [00:00:00 09/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [00:00:00 09/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 09/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 48 u1: cmH2O st: NotStopd t0: [00:00:00 09/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [00:00:00 09/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 09/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 09/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 09/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [00:00:00 09/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [00:00:00 09/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [00:00:00 09/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 09/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 290 u1: ml/B st: NotStopd t0: [00:00:00 09/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [00:00:00 09/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [01:00:00 09/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [01:00:00 09/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [01:00:00 09/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd
t0: [01:07:00 09/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.33 rs: Final st: NotStopd t0: [01:07:00 09/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 3 rs: Final st: NotStopd t0: [01:07:00 09/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 32 rs: Final st: NotStopd t0: [01:07:00 09/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 58 u1: mmHg rs: Final st: NotStopd t0: [01:07:00 09/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 127 u1: mmHg rs: Final st: NotStopd t0: [01:07:00 09/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.33 rs: Final st: NotStopd
t0: [01:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [01:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [01:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 09/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [01:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 82 u1: BPM st: NotStopd t0: [01:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [01:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [01:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [01:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [01:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 09/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 7.425 vu: ml t0: [01:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [01:00:00 09/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [01:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.03 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [01:30:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [01:30:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [01:30:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:30:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:30:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:30:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:30:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 84 u1: BPM st: NotStopd t0: [01:30:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:30:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [01:30:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [01:30:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:30:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [01:30:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [01:30:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:30:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [02:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [02:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 09/01/2016] id: Bladder Pressure el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [02:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 80 u1: BPM st: NotStopd t0: [02:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [02:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [02:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 09/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [02:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [02:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [02:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 09/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 6.1875 vu: ml t0: [02:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [02:00:00 09/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [01:30:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:30:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.02 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:30:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:05:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [02:05:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [02:05:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:05:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:05:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:05:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:05:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 79 u1: BPM st: NotStopd t0: [02:05:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:05:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [02:05:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [02:05:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:05:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [02:05:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [02:05:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:05:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:05:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:05:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.015 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:05:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [03:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [03:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 77 u1: BPM st: NotStopd t0: [03:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [03:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [03:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [03:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [03:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 09/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 3.40312 vu: ml t0: [03:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [03:00:00 09/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [03:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.01 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 09/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 30 cv: 30 ap: none t0: [23:00:00 09/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -1.93333 cv: -1.93333 ap: none t0: [23:00:00 09/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 17.6667 cv: 1001.24 ap: none t0: [23:00:00 09/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: 3161 pv: 28.0667 cv: 1153.24 ap: none t0: [23:00:00 09/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 30 cv: 372 ap: none t0: [23:00:00 09/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -1.93333 cv: 441.239 ap: none t0: [23:00:00 09/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 30 cv: 712 ap: none t0: [23:00:00 09/01/2016] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 140 ap: none t0: [23:00:00 09/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -1.93333 cv: 9476.75 ap: carryForward
t0: [03:55:00 09/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.37 rs: Final st: NotStopd t0: [03:55:00 09/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 3 rs: Final st: NotStopd t0: [03:55:00 09/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 31 rs: Final st: NotStopd t0: [03:55:00 09/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 51 u1: mmHg rs: Final st: NotStopd t0: [03:55:00 09/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 155 u1: mmHg rs: Final st: NotStopd t0: [03:55:00 09/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.37 rs: Final st: NotStopd
t0: [03:10:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [03:10:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [03:10:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:10:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:10:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:10:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:10:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [03:10:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:10:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [03:10:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [03:10:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:10:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [03:10:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [03:10:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [03:10:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:15:00 09/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [03:20:00 09/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [03:30:00 09/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [04:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [04:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 09/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 09/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 09/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 77 u1: BPM st: NotStopd t0: [04:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [04:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [04:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 09/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [04:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [04:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 25 u1: BPM st: NotStopd t0: [04:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 09/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [04:00:00 09/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2778 u1: Deg. C st: NotStopd t0: [04:00:00 09/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.3 u1: Deg. F st: NotStopd t0: [04:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 09/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 2.475 vu: ml t0: [04:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [04:00:00 09/01/2016] tf: [05:00:00 09/01/2016] dt: 60 id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 20 vu: ml
t0: [03:10:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:10:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.015 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:10:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.01 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 08/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [20:00:00 08/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [00:00:00 09/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [00:00:00 09/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [00:00:00 09/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 09/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [03:00:00 09/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:00:00 09/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [03:00:00 09/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 09/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 09/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:00:00 09/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 09/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 09/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [03:00:00 09/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [03:00:00 09/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [03:00:00 09/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 09/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 09/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 09/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 09/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [04:00:00 09/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 09/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 09/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 09/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 09/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 09/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [04:00:00 09/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 09/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [04:00:00 09/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 09/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 09/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [04:00:00 09/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 2 To pain st: NotStopd t0: [04:00:00 09/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Inconsistently st: NotStopd t0: [04:00:00 09/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 7 u1: points st: NotStopd t0: [04:00:00 09/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 09/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 09/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [04:00:00 09/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 09/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 09/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: Redness st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 09/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [04:00:00 09/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [04:00:00 09/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 09/01/2016] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 09/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: CSRU cg: RN v1: Soap & H20 st: NotStopd t0: [04:00:00 09/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [04:00:00 09/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 09/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 09/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Red st: NotStopd t0: [04:00:00 09/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 09/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [04:00:00 09/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Open v2: Erythema st: NotStopd t0: [04:00:00 09/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 09/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: Serous v2: Moderate st: NotStopd t0: [04:00:00 09/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 09/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: Dry Sterile Dsg v2: Changed st: NotStopd t0: [04:00:00 09/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 09/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 09/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 09/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 09/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Stimul st: NotStopd t0: [04:00:00 09/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [04:00:00 09/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 09/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 09/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [04:00:00 09/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 09/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 09/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 09/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [04:00:00 09/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 09/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 09/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 09/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [04:00:00 09/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 09/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 09/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 09/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 09/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 09/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 09/01/2016] id: Stool Guaiac el: 0 cu: CSRU cg: RN v1: Not Applicable st: NotStopd t0: [04:00:00 09/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 09/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 09/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 09/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 09/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Hypoactive st: NotStopd t0: [04:00:00 09/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 09/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 09/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 09/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [04:00:00 09/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 09/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 13 u1: number st: NotStopd t0: [04:00:00 09/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 09/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Positive st: NotStopd t0: [04:00:00 09/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [04:00:00 09/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 09/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 09/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 09/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Positive st: NotStopd t0: [04:00:00 09/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [04:00:00 09/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 09/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Serous v2: Small st: NotStopd t0: [04:00:00 09/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 09/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd
t0: [04:00:00 09/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 11 t0: [04:00:00 09/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [04:00:00 09/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [04:00:00 09/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 60 u1: cmH2O st: NotStopd t0: [04:00:00 09/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 09/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 3 st: NotStopd t0: [04:00:00 09/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 09/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 09/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [04:00:00 09/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 09/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 6.5 st: NotStopd t0: [04:00:00 09/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:00:00 09/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [04:00:00 09/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [04:00:00 09/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [04:00:00 09/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 09/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 48 u1: cmH2O st: NotStopd t0: [04:00:00 09/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 09/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 09/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 09/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 09/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [04:00:00 09/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [04:00:00 09/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [04:00:00 09/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 09/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [04:00:00 09/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [04:00:00 09/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [03:55:00 09/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [04:10:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [04:10:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [04:10:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:10:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:10:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:10:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:10:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [04:10:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:10:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [04:10:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [04:10:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:10:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [04:10:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [04:10:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [04:10:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:15:00 09/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd
t0: [04:10:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:10:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.005 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:10:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:12:00 09/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.4 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 30.8 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.4 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 30.8 rs: Final st: NotStopd
t0: [04:12:00 09/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 36 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Albumin Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.4 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 102 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 74 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.5 u1: mEq/L rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 139 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Total Bili Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: ALT Enzymes el: 0 cu: CSRU cg: 3161 v1: 36 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: AST Enzymes el: 0 cu: CSRU cg: 3161 v1: 88 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Albumin (>3.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.4 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Alk. Phosphate Enzymes el: 0 cu: CSRU cg: 3161 v1: 61 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 36 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 29 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 102 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 74 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: LDH Enzymes el: 0 cu: CSRU cg: 3161 v1: 193 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.5 u1: mEq/L rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 139 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd
t0: [04:12:00 09/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.8 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 13.8 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 34.4 u1: % rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 11.2 u1: gm/dl rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 190 rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.85 u1: /mic l rs: Final st: NotStopd t0: [04:12:00 09/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 13.8 rs: Final st: NotStopd
t0: [05:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [05:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [05:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 09/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [05:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [05:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [05:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [05:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [05:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 09/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 1.44375 vu: ml t0: [05:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [05:00:00 09/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [05:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0.005 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [06:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [06:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 09/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [06:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [06:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [06:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [06:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 09/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 1.2375 vu: ml t0: [06:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [06:00:00 09/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [06:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 57 u2: mmHg st: NotStopd
t0: [06:00:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [06:30:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [06:30:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 22 u1: mmHg st: NotStopd t0: [06:30:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:30:00 09/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [06:30:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:30:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:30:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:30:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [06:30:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:30:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [06:30:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [06:30:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:30:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [06:30:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [06:30:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:30:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:30:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:30:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:30:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [07:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [07:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [07:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 09/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [07:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [07:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [07:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [07:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [07:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [07:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 09/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 0 vu: ml t0: [07:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [07:00:00 09/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [07:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:00:00 09/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 09/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 15 degrees st: NotStopd t0: [06:00:00 09/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 09/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 09/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 09/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [06:00:00 09/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [06:00:00 09/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [06:00:00 09/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd
t0: [04:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN u1: mmHg st: NotStopd
t0: [08:16:00 09/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: -1 ai: 416 vo: 0 st: D/C'd
t0: [08:00:00 09/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 09/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 09/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 09/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 09/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [08:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [08:00:00 09/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 09/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 09/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 09/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 09/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [08:00:00 09/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 09/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 09/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 09/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 09/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 09/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 09/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Consistently st: NotStopd t0: [08:00:00 09/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 09/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 09/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [08:00:00 09/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 09/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 09/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [08:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 09/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 09/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 09/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 09/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 09/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 09/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 09/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 09/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 09/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [08:00:00 09/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 09/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 09/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 09/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 09/01/2016] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 09/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 09/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 09/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Transparent st: NotStopd t0: [08:00:00 09/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 09/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [08:00:00 09/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 09/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 09/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 09/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 09/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 09/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 09/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 09/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 09/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 09/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 09/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [08:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [08:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [08:00:00 09/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [08:00:00 09/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 09/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 65.7 u1: kg st: NotStopd t0: [08:00:00 09/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [08:00:00 09/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [08:00:00 09/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Bronchial st: NotStopd t0: [08:00:00 09/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Bronchial st: NotStopd t0: [08:00:00 09/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 09/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 09/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [08:00:00 09/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 09/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 09/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 09/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 09/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [08:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 09/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 09/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 09/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 09/01/2016] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.12688 u1: m2 st: NotStopd t0: [08:00:00 09/01/2016] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.31779 u1: m2 st: NotStopd t0: [08:00:00 09/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 09/01/2016] id: Weight Change el: 0 cu: CSRU cg: RN v1: 2.6 u1: kg st: NotStopd t0: [08:00:00 09/01/2016] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [08:00:00 09/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 09/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [08:00:00 09/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 09/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 09/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 09/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 09/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 09/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 09/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 09/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 09/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 09/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 09/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 09/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 09/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 09/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:15:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [08:15:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [08:15:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:15:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:15:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:15:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [08:15:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:15:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [08:15:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [08:15:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:15:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [08:15:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [08:15:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [08:15:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 09/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 0 vu: ml t0: [08:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [08:00:00 09/01/2016] tf: [09:53:00 12/01/2016] dt: 4433 id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml t0: [08:00:00 09/01/2016] tf: [20:00:00 11/01/2016] dt: 3600 id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 20 vu: ml
t0: [08:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:15:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:15:00 09/01/2016] id: Levophed-k el: 2 cu: CSRU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:15:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:30:00 09/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd
t0: [09:00:00 09/01/2016] id: Neg Insp Force(>-25) el: 0 cu: CSRU cg: -1 st: D/C'd t0: [09:00:00 09/01/2016] id: Vital Cap (>1.0)L el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [09:00:00 09/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 11.5 t0: [09:00:00 09/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [09:00:00 09/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [09:00:00 09/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 58 u1: cmH2O st: NotStopd t0: [09:00:00 09/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [09:00:00 09/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [09:00:00 09/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [09:00:00 09/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [09:00:00 09/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [09:00:00 09/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [09:00:00 09/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [09:00:00 09/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 8 v2: Combivent st: NotStopd t0: [09:00:00 09/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [09:00:00 09/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [09:00:00 09/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [09:00:00 09/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [09:00:00 09/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 47 u1: cmH2O st: NotStopd t0: [09:00:00 09/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [09:00:00 09/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [09:00:00 09/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [09:00:00 09/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [09:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [09:00:00 09/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [09:00:00 09/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [09:00:00 09/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [09:00:00 09/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [09:00:00 09/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [09:00:00 09/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [09:00:00 09/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 09/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 09/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [08:00:00 09/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [09:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [09:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [09:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [09:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [09:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [09:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [09:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [09:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [10:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [10:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [10:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [10:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [10:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [10:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 26 u1: BPM st: NotStopd t0: [10:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [09:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml t0: [10:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [10:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml
t0: [09:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [09:00:00 09/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thin st: NotStopd t0: [09:00:00 09/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd
t0: [10:15:00 09/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [10:15:00 09/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [10:15:00 09/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [10:15:00 09/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:15:00 09/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [10:15:00 09/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:15:00 09/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [10:15:00 09/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd
t0: [11:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [11:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [11:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [11:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [11:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [11:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [11:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [11:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [11:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml t0: [11:00:00 09/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 30 vu: ml
t0: [11:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 09/01/2016] id: O2 Delivery Device el: 0 cu: CSRU cg: -1 st: D/C'd t0: [12:00:00 09/01/2016] id: O2 Flow (lpm) el: 0 cu: CSRU cg: -1 st: D/C'd
t0: [12:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [12:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [12:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [12:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [12:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [12:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [12:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [12:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml
t0: [12:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:12:00 09/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [12:12:00 09/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 74 rs: Final st: NotStopd t0: [12:12:00 09/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.7 rs: Final st: NotStopd t0: [12:12:00 09/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 4 rs: Final st: NotStopd t0: [12:12:00 09/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 30 rs: Final st: NotStopd t0: [12:12:00 09/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [12:12:00 09/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 145 u1: mmHg rs: Final st: NotStopd t0: [12:12:00 09/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [12:12:00 09/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 74 rs: Final st: NotStopd t0: [12:12:00 09/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.7 rs: Final st: NotStopd
t0: [12:45:00 09/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 11.5 t0: [12:45:00 09/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [12:45:00 09/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [12:45:00 09/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 58 u1: cmH2O st: NotStopd t0: [12:45:00 09/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:45:00 09/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [12:45:00 09/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:45:00 09/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [12:45:00 09/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [12:45:00 09/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:45:00 09/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [12:45:00 09/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [12:45:00 09/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [12:45:00 09/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [12:45:00 09/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [12:45:00 09/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [12:45:00 09/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 48 u1: cmH2O st: NotStopd t0: [12:45:00 09/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [12:45:00 09/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [12:45:00 09/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [12:45:00 09/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:45:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:45:00 09/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [12:45:00 09/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [12:45:00 09/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [12:45:00 09/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [12:45:00 09/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [12:45:00 09/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [12:45:00 09/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [12:45:00 09/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [12:45:00 09/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White v2: Thick st: NotStopd t0: [12:45:00 09/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd
t0: [12:03:00 09/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 11.7 rs: Final st: NotStopd t0: [12:03:00 09/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 11.7 rs: Final st: NotStopd t0: [12:03:00 09/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 32.3 u1: % rs: Final st: NotStopd t0: [12:03:00 09/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 11.3 u1: gm/dl rs: Final st: NotStopd t0: [12:03:00 09/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 184 rs: Final st: NotStopd t0: [12:03:00 09/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.62 u1: /mic l rs: Final st: NotStopd t0: [12:03:00 09/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 11.7 rs: Final st: NotStopd
t0: [12:00:00 09/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 09/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:30:00 09/01/2016] id: Radiologic Study el: 0 cu: CSRU cg: RN v1: Chest Xray st: NotStopd t0: [13:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [13:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [13:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [13:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [13:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [13:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [13:00:00 09/01/2016] id: Procedures el: 0 cu: CSRU cg: RN v1: Blood Cultured st: NotStopd t0: [13:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [13:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:30:00 09/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [13:30:00 09/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [13:30:00 09/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [13:30:00 09/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:30:00 09/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [13:30:00 09/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:30:00 09/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [13:30:00 09/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [13:30:00 09/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [13:30:00 09/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.2 u1: Deg. F st: NotStopd t0: [13:30:00 09/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [13:30:00 09/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 09/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 09/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 09/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [14:00:00 09/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [14:00:00 09/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [14:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [14:00:00 09/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 09/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 09/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 09/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [14:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 09/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [14:00:00 09/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [14:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 09/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [14:00:00 09/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [14:00:00 09/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 09/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [14:00:00 09/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Consistently st: NotStopd t0: [14:00:00 09/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [14:00:00 09/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 09/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [14:00:00 09/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [14:00:00 09/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [14:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 09/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 09/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [14:00:00 09/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [14:00:00 09/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Serous v2: Small st: NotStopd t0: [14:00:00 09/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [14:00:00 09/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [14:00:00 09/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [14:00:00 09/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [14:00:00 09/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [14:00:00 09/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 09/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 09/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 09/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 09/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [14:00:00 09/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 09/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [14:00:00 09/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:00:00 09/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 09/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [14:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [14:00:00 09/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 09/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [14:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [14:00:00 09/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [14:00:00 09/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [14:00:00 09/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 09/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:00:00 09/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [14:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [14:00:00 09/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 09/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 09/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 09/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 09/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 09/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 09/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 09/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 09/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [14:00:00 09/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 09/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 09/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 09/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [14:00:00 09/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [13:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [13:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml t0: [14:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [14:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml
t0: [13:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [15:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [15:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 87 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [15:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [15:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [15:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [15:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [15:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml
t0: [15:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [16:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [16:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [16:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [16:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [16:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [16:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [16:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [16:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [16:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:09:00 09/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.41 rs: Final st: NotStopd t0: [16:09:00 09/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 3 rs: Final st: NotStopd t0: [16:09:00 09/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 29 rs: Final st: NotStopd t0: [16:09:00 09/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [16:09:00 09/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 170 u1: mmHg rs: Final st: NotStopd t0: [16:09:00 09/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.41 rs: Final st: NotStopd
tf: [03:00:00 10/01/2016] pt: IV Piggyback rt: IV fr: INFUSION m1: Bumetanide v1: 12 u1: mg m2: D5W v2: 500 u2: ml tf: [11:00:00 10/01/2016] pt: Unit Dose rt: IV fr: Q4H fs: 17, 21, 1, 5, 9, 13 dn: 6 m1: Albumin 25% (12.5gm) v1: 25 u1: gm tf: [12:00:00 12/01/2016] pt: Unit Dose rt: IV fr: Q4H fs: 17, 21, 1, 5, 9, 13 dn: 6 m1: Albumin 25% (12.5gm) v1: 25 u1: gm
t0: [17:00:00 09/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 11.5 t0: [17:00:00 09/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [17:00:00 09/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [17:00:00 09/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 58 u1: cmH2O st: NotStopd t0: [17:00:00 09/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [17:00:00 09/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [17:00:00 09/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 09/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 09/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [17:00:00 09/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 09/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [17:00:00 09/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [17:00:00 09/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [17:00:00 09/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.9 u1: L/min st: NotStopd t0: [17:00:00 09/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [17:00:00 09/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 09/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 47 u1: cmH2O st: NotStopd t0: [17:00:00 09/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [17:00:00 09/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [17:00:00 09/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [17:00:00 09/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [17:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 97 u1: % st: NotStopd t0: [17:00:00 09/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [17:00:00 09/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [17:00:00 09/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [17:00:00 09/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 09/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 330 u1: ml/B st: NotStopd t0: [17:00:00 09/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [17:00:00 09/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [17:00:00 09/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [17:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [17:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 23 u1: mmHg st: NotStopd t0: [17:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 09/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [17:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [17:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 09/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [17:00:00 09/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [17:00:00 09/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [17:00:00 09/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [17:00:00 09/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [17:00:00 09/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [17:00:00 09/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [17:00:00 09/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [17:00:00 09/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [17:00:00 09/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [17:00:00 09/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [17:00:00 09/01/2016] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Dampened st: NotStopd t0: [17:00:00 09/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 09/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [17:00:00 09/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [17:00:00 09/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 98 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [17:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [17:00:00 09/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [17:00:00 09/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 09/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [17:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [17:00:00 09/01/2016] id: Procedures el: 0 cu: CSRU cg: RN v1: Ultrasound st: NotStopd t0: [17:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [17:00:00 09/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [17:00:00 09/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36 u1: Deg. C st: NotStopd t0: [17:00:00 09/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.8 u1: Deg. F st: NotStopd t0: [17:00:00 09/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [17:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:00:00 09/01/2016] id: Packed RBC's IV Infusions el: 2 cu: CSRU cg: -1 ai: 155 vo: 0 st: D/C'd t0: [18:00:00 09/01/2016] id: Fresh Frozen Plasma IV Infusions el: 1 cu: CSRU cg: -1 ai: -1 vo: 0 st: D/C'd t0: [18:00:00 09/01/2016] id: Hespan IV Infusions el: 1 cu: CSRU cg: -1 ai: -1 vo: 0 st: D/C'd
tf: [20:00:00 10/01/2016] pt: IV Piggyback rt: IV fr: Q8H fs: 2, 10, 18 dn: 3 m1: Piperacillin-Tazobactam Na v1: 2.25 u1: gm m2: Iso-Osmotic Dextrose v2: 50 u2: ml
id: Albumin 25% el: 1 cu: CSRU cg: RN io: Albumin 25% Tube Feeding du: ml rt: Intravenous Push
t0: [18:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [18:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [18:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [18:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 09/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [18:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [18:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [18:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [18:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [17:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml t0: [18:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 09/01/2016] tf: [09:53:00 12/01/2016] dt: 3833 id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml t0: [18:00:00 09/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [18:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [18:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [18:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 09/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 10 vu: ml t0: [18:00:00 09/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 20 vu: ml
t0: [18:00:00 09/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [18:00:00 09/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [18:00:00 09/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [18:00:00 09/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [18:00:00 09/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [18:00:00 09/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [18:00:00 09/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [18:00:00 09/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [18:00:00 09/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [18:00:00 09/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [18:00:00 09/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [18:00:00 09/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [18:00:00 09/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Soft Distended st: NotStopd t0: [18:00:00 09/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 09/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 09/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [18:00:00 09/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [18:00:00 09/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 09/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [18:00:00 09/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [18:00:00 09/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [18:00:00 09/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [18:00:00 09/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [18:00:00 09/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [18:00:00 09/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [18:00:00 09/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [18:00:00 09/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [18:00:00 09/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [19:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [19:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [19:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [19:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [19:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [19:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [19:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [19:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [19:00:00 09/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25
t0: [20:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [20:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [20:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [20:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [20:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [20:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [20:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [20:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [20:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 20 vu: ml t0: [20:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 7 vu: ml
t0: [20:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 09/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 09/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [20:00:00 09/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98 u1: Deg. F st: NotStopd
t0: [20:00:00 09/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [20:00:00 09/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [20:00:00 09/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.5 u1: torr st: NotStopd t0: [20:00:00 09/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 58 u1: cmH2O st: NotStopd t0: [20:00:00 09/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 09/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 3 st: NotStopd t0: [20:00:00 09/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 09/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 09/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [20:00:00 09/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 09/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [20:00:00 09/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [20:00:00 09/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [20:00:00 09/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [20:00:00 09/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [20:00:00 09/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 09/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 48 u1: cmH2O st: NotStopd t0: [20:00:00 09/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [20:00:00 09/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 09/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 09/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 09/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [20:00:00 09/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [20:00:00 09/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [20:00:00 09/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 09/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [20:00:00 09/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [20:00:00 09/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 09/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25
t0: [20:00:00 09/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 09/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Positive st: NotStopd t0: [20:00:00 09/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 09/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [20:00:00 09/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Grimace Scale st: NotStopd t0: [20:00:00 09/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 09/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 09/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 09/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 09/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 09/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 09/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 09/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 09/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 09/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 09/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 09/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [20:00:00 09/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 09/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 09/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 09/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 09/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 09/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 09/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Stimul st: NotStopd t0: [20:00:00 09/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 09/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 09/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 09/01/2016] id: Pain Location el: 0 cu: CSRU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 09/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 09/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [20:00:00 09/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 09/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 09/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 09/01/2016] id: Stool Color/Consist el: 0 cu: CSRU cg: RN v1: Golden st: NotStopd t0: [20:00:00 09/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 09/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 09/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [20:00:00 09/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 09/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 09/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 09/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 09/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 09/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 09/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd
t0: [20:00:00 09/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 09/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 09/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 09/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 09/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 09/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 09/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 09/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 09/01/2016] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 09/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 09/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 09/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 09/01/2016] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 09/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 09/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [20:00:00 09/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [20:00:00 09/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Serous v2: Scant st: NotStopd t0: [20:00:00 09/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 09/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 09/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 09/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [20:00:00 09/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [20:00:00 09/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 09/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 09/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 09/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 09/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 09/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 09/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 09/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 09/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 09/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 1 Person Assist st: NotStopd t0: [20:00:00 09/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 09/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 09/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 09/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 09/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 09/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 09/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 09/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 09/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 09/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 09/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 09/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd
t0: [21:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [21:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [21:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [21:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 91 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [21:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [21:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [21:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [21:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [21:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [21:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [22:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [22:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [22:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [22:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [22:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [22:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [22:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 09/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml t0: [22:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [22:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [22:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:10:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:10:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [22:10:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:10:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:10:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [22:10:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [22:10:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [22:10:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:10:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [22:10:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [22:10:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:10:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:15:00 09/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd
t0: [22:10:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:10:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 09/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:00:00 09/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [23:00:00 09/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 09/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 09/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [23:00:00 09/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [23:00:00 09/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [23:00:00 09/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 09/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [23:00:00 09/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [23:00:00 09/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 09/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 09/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 09/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [23:00:00 09/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 2.66667 vu: ml
t0: [23:00:00 09/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 09/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:08:00 09/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.44 rs: Final st: NotStopd t0: [23:08:00 09/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.9 rs: Final st: NotStopd t0: [23:08:00 09/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 2 rs: Final st: NotStopd t0: [23:08:00 09/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 27 rs: Final st: NotStopd t0: [23:08:00 09/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 39 u1: mmHg rs: Final st: NotStopd t0: [23:08:00 09/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 179 u1: mmHg rs: Final st: NotStopd t0: [23:08:00 09/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.44 rs: Final st: NotStopd t0: [23:08:00 09/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.9 rs: Final st: NotStopd
t0: [23:00:00 09/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 09/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 09/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [00:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [00:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 10/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [00:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [00:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [00:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [00:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [00:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 10/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 10/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 10/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 10/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 10/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 10/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 10/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 10/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 10/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [00:00:00 10/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 10/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 10/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 10/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 10/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [00:00:00 10/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [00:00:00 10/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 10/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd
t0: [00:00:00 10/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [00:00:00 10/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [00:00:00 10/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 10/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [00:00:00 10/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 10/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 3 st: NotStopd t0: [00:00:00 10/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 10/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 10/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [00:00:00 10/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 10/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [00:00:00 10/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [00:00:00 10/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [00:00:00 10/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [00:00:00 10/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [00:00:00 10/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 10/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 46 u1: cmH2O st: NotStopd t0: [00:00:00 10/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [00:00:00 10/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 10/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 10/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 10/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [00:00:00 10/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [00:00:00 10/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [00:00:00 10/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [00:00:00 10/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [00:00:00 10/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [00:00:00 10/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 10/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 10/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Copious st: NotStopd
t0: [01:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [01:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [01:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 10/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [01:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 90 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [01:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [01:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [01:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [01:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 20 vu: ml t0: [01:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 6 vu: ml
t0: [01:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [01:00:00 10/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [01:00:00 10/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd
t0: [02:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [02:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [02:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 10/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [02:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [02:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [02:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [02:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [02:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [02:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 09/01/2016] tf: [09:53:00 12/01/2016] dt: 3773 id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [20:00:00 09/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [21:00:00 09/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [22:00:00 09/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [23:00:00 09/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [00:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [01:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [02:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [02:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [02:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml
t0: [02:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [21:00:00 09/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [22:00:00 09/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [23:00:00 09/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [00:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [01:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [02:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25
t0: [02:00:00 10/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml
t0: [02:13:00 10/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd t0: [02:13:00 10/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 3 rs: Final st: NotStopd t0: [02:13:00 10/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [02:13:00 10/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 41 u1: mmHg rs: Final st: NotStopd t0: [02:13:00 10/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 119 u1: mmHg rs: Final st: NotStopd t0: [02:13:00 10/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.43 rs: Final st: NotStopd
t0: [23:00:00 09/01/2016] dt: 24 id: Colloids Total el: 3 cu: CSRU cg: 3161 cv: 100 ap: none t0: [23:00:00 10/01/2016] dt: 24 id: Colloids Total el: 3 cu: CSRU cg: RN cv: 250 ap: none
t0: [02:00:00 10/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 40 vu: ml
t0: [03:00:00 10/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 44 u1: cmH2O st: NotStopd t0: [03:00:00 10/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd
t0: [03:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [03:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [03:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 10/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [03:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [03:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [03:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [03:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [03:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [03:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 96 u1: % st: NotStopd t0: [03:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd
t0: [03:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [03:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [03:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml
t0: [03:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [04:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [04:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [04:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [04:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [04:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [04:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [04:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [04:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [04:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml
t0: [04:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:00:00 10/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 40 vu: ml
t0: [00:00:00 10/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [00:00:00 10/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 6 u1: points st: NotStopd t0: [00:00:00 10/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Stimul st: NotStopd t0: [00:00:00 10/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [00:00:00 10/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 10/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd
tf: [12:00:00 12/01/2016] pt: IV Piggyback rt: IV fr: INFUSION dn: 0 m1: Bumetanide v1: 12 u1: mg m2: D5W v2: 500 u2: ml
t0: [04:00:00 10/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 10/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [04:17:00 10/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.39 rs: Final st: NotStopd t0: [04:17:00 10/01/2016] id: CaO2 el: 0 cu: CSRU cg: 3161 v1: 15.2639 u1: ml/dl st: NotStopd t0: [04:17:00 10/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 2 rs: Final st: NotStopd t0: [04:17:00 10/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [04:17:00 10/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [04:17:00 10/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 137 u1: mmHg rs: Final st: NotStopd t0: [04:17:00 10/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.39 rs: Final st: NotStopd t0: [04:17:00 10/01/2016] id: SaO2 ABG's el: 0 cu: CSRU cg: 3161 v1: 98 u1: % rs: Final st: NotStopd
t0: [04:00:00 10/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 10/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36 u1: Deg. C st: NotStopd t0: [04:00:00 10/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 96.8 u1: Deg. F st: NotStopd
t0: [00:00:00 10/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 10/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 10/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [04:00:00 10/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd
t0: [04:00:00 10/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 10/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Positive st: NotStopd t0: [04:00:00 10/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 10/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 10/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 10/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [04:00:00 10/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 10/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 10/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 10/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 10/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 10/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 10/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 10/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 10/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [04:00:00 10/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 10/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 10/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 10/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 10/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 10/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [04:00:00 10/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Sanguinous st: NotStopd
t0: [04:00:00 10/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 10/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 10/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 10/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Stimul st: NotStopd t0: [04:00:00 10/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 10/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 10/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 10/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [04:00:00 10/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [04:00:00 10/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd
t0: [04:00:00 10/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 10/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [04:00:00 10/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [04:00:00 10/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 10/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Purple st: NotStopd t0: [04:00:00 10/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 10/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [04:00:00 10/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 10/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 10/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 10/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 10/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 10/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 10/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd
t0: [04:00:00 10/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [04:00:00 10/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [04:00:00 10/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 10/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [04:00:00 10/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 10/01/2016] id: I:E Ratio el: 0 cu: CSRU cg: RRT v1: 3 st: NotStopd t0: [04:00:00 10/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 10/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 10/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 10/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 10/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8 st: NotStopd t0: [04:00:00 10/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [04:00:00 10/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [04:00:00 10/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [04:00:00 10/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [04:00:00 10/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 10/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 44 u1: cmH2O st: NotStopd t0: [04:00:00 10/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 10/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 10/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 10/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 10/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [04:00:00 10/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 10/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [04:00:00 10/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [04:00:00 10/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [04:00:00 10/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [04:00:00 10/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [05:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [05:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [05:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 10/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [05:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 95 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [05:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [05:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [05:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [05:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [05:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [05:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml
t0: [05:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [05:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25
t0: [06:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [06:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [06:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [06:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 84 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [06:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [06:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [06:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [06:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [06:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [06:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml
t0: [06:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:00:00 10/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 30 vu: ml
t0: [06:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [07:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [07:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [07:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [07:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [07:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [07:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [07:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [07:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [07:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [07:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [07:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml
t0: [07:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [07:00:00 10/01/2016] id: Gastric Nasogastric el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [23:00:00 10/01/2016] dt: 24 id: Gastric Out Total el: 3 cu: CSRU cg: RN cv: 50 ap: none
t0: [08:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [08:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [08:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [08:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [08:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 102 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [08:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [08:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [08:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [08:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [08:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [08:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [08:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml
t0: [08:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [09:00:00 10/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [09:00:00 10/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [09:00:00 10/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [09:00:00 10/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Orientation st: NotStopd t0: [09:00:00 10/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [09:00:00 10/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [09:00:00 10/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [09:00:00 10/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [09:00:00 10/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [09:00:00 10/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [09:00:00 10/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [09:00:00 10/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN st: NotStopd t0: [09:00:00 10/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [09:00:00 10/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [09:00:00 10/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [09:00:00 10/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [09:00:00 10/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [09:00:00 10/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [09:00:00 10/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Consistently st: NotStopd t0: [09:00:00 10/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [09:00:00 10/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [09:00:00 10/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [09:00:00 10/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [09:00:00 10/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [09:00:00 10/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 10/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [09:00:00 10/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [09:00:00 10/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [09:00:00 10/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [09:00:00 10/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [09:00:00 10/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [09:00:00 10/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated st: NotStopd t0: [09:00:00 10/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 10/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 10/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 10/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 10/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [09:00:00 10/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [09:00:00 10/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Exp Wheeze st: NotStopd t0: [09:00:00 10/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Exp Wheeze st: NotStopd t0: [09:00:00 10/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [09:00:00 10/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [09:00:00 10/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [09:00:00 10/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [09:00:00 10/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [09:00:00 10/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [09:00:00 10/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Exp Wheeze st: NotStopd t0: [09:00:00 10/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Exp Wheeze st: NotStopd t0: [09:00:00 10/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [09:00:00 10/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [09:00:00 10/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [09:00:00 10/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [09:00:00 10/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [09:00:00 10/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [09:00:00 10/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 10/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [09:00:00 10/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 10/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [09:00:00 10/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [09:00:00 10/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [09:00:00 10/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [09:00:00 10/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [09:00:00 10/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [09:00:00 10/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Potential Prob st: NotStopd t0: [09:00:00 10/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [09:00:00 10/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [09:00:00 10/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [09:00:00 10/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 12 u1: number st: NotStopd t0: [09:00:00 10/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [09:00:00 10/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [09:00:00 10/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 10/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [09:00:00 10/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [09:00:00 10/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [09:00:00 10/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [09:00:00 10/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [09:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [09:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [09:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml t0: [09:00:00 10/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 20 vu: ml
t0: [07:00:00 10/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [07:00:00 10/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [07:00:00 10/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [07:00:00 10/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [07:00:00 10/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [07:00:00 10/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [07:00:00 10/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [07:00:00 10/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 10/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 10/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 10/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 10/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 10/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 10/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 10/01/2016] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 10/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 10/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [09:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [09:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [09:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 71 u1: BPM st: NotStopd t0: [09:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [09:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [09:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [09:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [09:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [09:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:25:00 10/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.8 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 33.7 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.8 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 33.7 rs: Final st: NotStopd
t0: [09:00:00 10/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [09:00:00 10/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.2778 u1: Deg. C st: NotStopd t0: [09:00:00 10/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.3 u1: Deg. F st: NotStopd
t0: [08:25:00 10/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 10.6 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 10.6 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 32.9 u1: % rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.8 u1: gm/dl rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 211 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.58 u1: /mic l rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 10.6 rs: Final st: NotStopd
t0: [08:25:00 10/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 40 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.3 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 57 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.6 u1: mEq/L rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Total Bili Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: ALT Enzymes el: 0 cu: CSRU cg: 3161 v1: 25 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: AST Enzymes el: 0 cu: CSRU cg: 3161 v1: 41 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Alk. Phosphate Enzymes el: 0 cu: CSRU cg: 3161 v1: 67 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 40 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 27 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.3 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 57 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.8 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 5.6 u1: mEq/L rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.8 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd t0: [08:25:00 10/01/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd
t0: [09:30:00 10/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [09:30:00 10/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [09:30:00 10/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [09:30:00 10/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [09:30:00 10/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [09:30:00 10/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [09:30:00 10/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [09:30:00 10/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [09:30:00 10/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [09:30:00 10/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [09:30:00 10/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [09:30:00 10/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [09:30:00 10/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [09:30:00 10/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [09:30:00 10/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 44 u1: cmH2O st: NotStopd t0: [09:30:00 10/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [09:30:00 10/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [09:30:00 10/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [09:30:00 10/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [09:30:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [09:30:00 10/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: White v2: Thick st: NotStopd t0: [09:30:00 10/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [09:30:00 10/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [09:30:00 10/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [09:30:00 10/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [09:30:00 10/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [09:30:00 10/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 347 u1: ml/B st: NotStopd t0: [09:30:00 10/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [09:30:00 10/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [09:30:00 10/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [10:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [10:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [10:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [10:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [10:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [10:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [10:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [10:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [10:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [10:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [10:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml
t0: [10:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [11:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [11:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [11:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [11:00:00 10/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [11:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [11:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [11:00:00 10/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 10/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [11:00:00 10/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [11:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [11:00:00 10/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 10/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [11:00:00 10/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [11:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [11:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [11:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 10/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 09/01/2016] id: Gastric Nasogastric el: 1 cu: CSRU cg: RN vo: 200 vu: ml t0: [11:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [11:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [11:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml
t0: [11:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 09/01/2016] dt: 24 id: Gastric Out Total el: 3 cu: CSRU cg: RN cv: 200 ap: none
t0: [11:00:00 10/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd
t0: [10:00:00 10/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 10/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 10/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 10/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [12:00:00 10/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [12:00:00 10/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 10/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 10/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 10/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 10/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [12:00:00 10/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 10/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 10/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [12:00:00 10/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 10/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [12:00:00 10/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 10/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [12:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 10/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [12:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [12:00:00 10/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [12:00:00 10/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [12:00:00 10/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 10/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [12:00:00 10/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [12:00:00 10/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated st: NotStopd t0: [12:00:00 10/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 10/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 10/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 10/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 10/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 10/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 10/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [12:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [12:00:00 10/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [12:00:00 10/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 10/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 10/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [12:00:00 10/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 10/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 10/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 10/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 10/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [12:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 10/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 10/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 10/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 10/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 10/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [12:00:00 10/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 10/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 10/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 10/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 10/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [12:00:00 10/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 10/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [12:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [12:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [12:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml t0: [12:00:00 10/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 30 vu: ml
t0: [12:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 10/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [12:00:00 10/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Ins/Exp Wheeze st: NotStopd
t0: [12:00:00 10/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [12:00:00 10/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [12:00:00 10/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 10/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [12:00:00 10/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:00:00 10/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 10/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 10/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 10/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 10/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 6 st: NotStopd t0: [12:00:00 10/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [12:00:00 10/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [12:00:00 10/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [12:00:00 10/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [12:00:00 10/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 10/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 43 u1: cmH2O st: NotStopd t0: [12:00:00 10/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [12:00:00 10/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [12:00:00 10/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [12:00:00 10/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [12:00:00 10/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Blood Tinged v2: Thin st: NotStopd t0: [12:00:00 10/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [12:00:00 10/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [12:00:00 10/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3.0 st: NotStopd t0: [12:00:00 10/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [12:00:00 10/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [12:00:00 10/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [12:00:00 10/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [12:00:00 10/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [12:00:00 10/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 10/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [13:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [13:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [13:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [13:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [13:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 110 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [13:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [13:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [13:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [13:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [13:00:00 10/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [13:00:00 10/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.5 u1: Deg. C st: NotStopd t0: [13:00:00 10/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.7 u1: Deg. F st: NotStopd t0: [13:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [13:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [13:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3 vu: ml
t0: [13:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
pt: TPN
t0: [14:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [14:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [14:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [14:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [14:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 117 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [14:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [14:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [14:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [14:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [14:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [14:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [14:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:00:00 10/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml t0: [10:25:00 10/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vu: ml t0: [10:30:00 10/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vu: ml t0: [14:00:00 10/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml
t0: [14:15:00 10/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [14:15:00 10/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [14:15:00 10/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [14:15:00 10/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [14:15:00 10/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [14:15:00 10/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [14:15:00 10/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [14:15:00 10/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [14:15:00 10/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:15:00 10/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [14:15:00 10/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:15:00 10/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [14:15:00 10/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd
t0: [15:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [15:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [15:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [15:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 108 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [15:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [15:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [15:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [15:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [15:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [15:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml t0: [15:00:00 10/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 40 vu: ml
t0: [15:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 10/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CSRU cg: RN v1: 62 rs: Manual st: NotStopd
t0: [16:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [16:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [16:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [16:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [16:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 106 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [16:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [16:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [16:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [16:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [16:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [16:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [16:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [16:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:30:00 10/01/2016] id: Family Communication el: 0 cu: CSRU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 10/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 10/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 10/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [16:00:00 10/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 10/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 10/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 10/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 10/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 10/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [16:00:00 10/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 10/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 10/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [16:00:00 10/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 10/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 10/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 10/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [16:00:00 10/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 10/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 10/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 10/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [16:00:00 10/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 10/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [16:00:00 10/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 10/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Serous st: NotStopd t0: [16:00:00 10/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [16:00:00 10/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 10/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Purple st: NotStopd t0: [16:00:00 10/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 10/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [16:00:00 10/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [16:00:00 10/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated st: NotStopd t0: [16:00:00 10/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 10/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 10/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 10/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 10/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 10/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 10/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 10/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 10/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 10/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 10/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [16:00:00 10/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [16:00:00 10/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 10/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 10/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 10/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [16:00:00 10/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 10/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 10/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 10/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 10/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 10/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 10/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 10/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 10/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 10/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [16:00:00 10/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [16:00:00 10/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [16:15:00 10/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: White v2: Thin st: NotStopd t0: [16:15:00 10/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Scant st: NotStopd
io: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ra: 42 ru: ml/hr
id: TPN el: 1 cu: CSRU cg: RN io: TPN 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push
t0: [17:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [17:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [17:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [17:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [17:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [17:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [17:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 109 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [17:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [17:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [17:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [17:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [17:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [17:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [17:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [17:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml t0: [17:00:00 10/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 30 vu: ml
t0: [17:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [17:00:00 10/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [17:00:00 10/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [17:00:00 10/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.9 u1: Deg. F st: NotStopd
t0: [17:00:00 10/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 0 vu: ml
t0: [17:30:00 10/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [17:30:00 10/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [17:30:00 10/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [17:30:00 10/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [17:30:00 10/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [17:30:00 10/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [17:30:00 10/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:30:00 10/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd
t0: [18:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [18:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [18:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [18:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 119 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [18:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [18:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [18:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 29 u1: BPM st: NotStopd t0: [18:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 10/01/2016] tf: [09:53:00 12/01/2016] dt: 2393 id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [18:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [18:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [18:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [18:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [09:00:00 10/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [18:00:00 10/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd
t0: [18:00:00 10/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [18:00:00 10/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [18:00:00 10/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [18:00:00 10/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [18:00:00 10/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [18:00:00 10/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [18:00:00 10/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [18:00:00 10/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [18:00:00 10/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [18:00:00 10/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 6 st: NotStopd t0: [18:00:00 10/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [18:00:00 10/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.1 u1: L/min st: NotStopd t0: [18:00:00 10/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [18:00:00 10/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [18:00:00 10/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 44 u1: cmH2O st: NotStopd t0: [18:00:00 10/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [18:00:00 10/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [18:00:00 10/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [18:00:00 10/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [18:00:00 10/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [18:00:00 10/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3.0 st: NotStopd t0: [18:00:00 10/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [18:00:00 10/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [18:00:00 10/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [18:00:00 10/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 335 u1: ml/B st: NotStopd t0: [18:00:00 10/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [18:00:00 10/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [18:00:00 10/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [19:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [19:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [19:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [19:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [19:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 115 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [19:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [19:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [19:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 38 u1: BPM st: NotStopd t0: [19:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 10/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [19:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [19:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [19:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [19:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:45:00 10/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml
t0: [20:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [20:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [20:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [20:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 126 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [20:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [20:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [20:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [20:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [20:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 10/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [20:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [20:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [20:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [20:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 10/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 10/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.5 u1: Deg. C st: NotStopd t0: [20:00:00 10/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.7 u1: Deg. F st: NotStopd
t0: [20:00:00 10/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [20:00:00 10/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [20:00:00 10/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 10/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [20:00:00 10/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 10/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 10/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 10/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 10/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 10/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 9 st: NotStopd t0: [20:00:00 10/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [20:00:00 10/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [20:00:00 10/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [20:00:00 10/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 10/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 44 u1: cmH2O st: NotStopd t0: [20:00:00 10/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [20:00:00 10/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 10/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 10/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [20:00:00 10/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [20:00:00 10/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 3 st: NotStopd t0: [20:00:00 10/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 10/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [20:00:00 10/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [20:00:00 10/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [20:00:00 10/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [20:00:00 10/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 10/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd
t0: [20:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25
t0: [21:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [21:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [21:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 10/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [21:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [21:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 125 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [21:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [21:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [21:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [21:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 10/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [21:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [21:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [21:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [21:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [22:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 10/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [22:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 119 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [22:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [22:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [22:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [22:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 10/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [22:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [22:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [22:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [22:00:00 10/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [23:00:00 10/01/2016] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 280 ap: none
t0: [22:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [23:00:00 10/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:00:00 10/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [23:00:00 10/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 10/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 10/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 10/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 10/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [23:00:00 10/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 10/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [23:00:00 10/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 117 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [23:00:00 10/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [23:00:00 10/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 10/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [23:00:00 10/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [23:00:00 10/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 10/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 10/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 10/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 10/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 10/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [23:00:00 10/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [23:00:00 10/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [23:00:00 10/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [23:00:00 10/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 90 cv: 90 ap: none t0: [23:00:00 10/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 18.5 cv: 837 ap: none t0: [23:00:00 10/01/2016] dt: 24 id: IV Nutrition Total el: 3 cu: CSRU cg: RN pv: 42 cv: 252 ap: none t0: [23:00:00 10/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 90 cv: 1269 ap: none t0: [23:00:00 10/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 90 cv: 1599 ap: none
t0: [20:00:00 10/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 10/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 10/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 10/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 10/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 10/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 10/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 10/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 10/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 10/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 10/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 10/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 10/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 10/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 10/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 10/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 10/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 10/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 10/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [20:00:00 10/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 10/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 10/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 10/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 10/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 10/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 10/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 10/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 10/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 10/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 10/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [20:00:00 10/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 10/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 10/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 10/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 10/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 10/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [20:00:00 10/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 10/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Serous v2: Small st: NotStopd t0: [20:00:00 10/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 10/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [20:00:00 10/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Purple st: NotStopd t0: [20:00:00 10/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 10/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [20:00:00 10/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 10/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated st: NotStopd t0: [20:00:00 10/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 10/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 10/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 10/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 10/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 10/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 10/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 10/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 10/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 10/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 10/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 10/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 10/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 10/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 10/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 10/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 10/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 10/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [20:00:00 10/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 10/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 10/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 10/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 10/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 10/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 10/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 10/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 10/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 10/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Intact st: NotStopd t0: [20:00:00 10/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 10/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 10/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 10/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 10/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 10/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 10/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [20:00:00 10/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 10/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 10/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 10/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 10/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 10/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [20:00:00 10/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [00:00:00 11/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [00:00:00 11/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [00:00:00 11/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 11/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [00:00:00 11/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 11/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 11/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 11/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 11/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 11/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 9 st: NotStopd t0: [00:00:00 11/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Combivent st: NotStopd t0: [00:00:00 11/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [00:00:00 11/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 10.5 u1: L/min st: NotStopd t0: [00:00:00 11/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [00:00:00 11/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 11/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 44 u1: cmH2O st: NotStopd t0: [00:00:00 11/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [00:00:00 11/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 11/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 11/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [00:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:00:00 11/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [00:00:00 11/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 3 st: NotStopd t0: [00:00:00 11/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 11/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [00:00:00 11/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [00:00:00 11/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [00:00:00 11/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [00:00:00 11/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 11/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [00:00:00 11/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: Scant st: NotStopd
t0: [00:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [00:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [00:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [00:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml t0: [00:00:00 11/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [23:00:00 11/01/2016] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 317 ap: none
t0: [20:00:00 10/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 10/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [00:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [00:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 11/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 11/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [00:00:00 11/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [00:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [00:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 120 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [00:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [00:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 11/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [00:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [00:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 10/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [00:00:00 11/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 11/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [01:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [01:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [01:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [01:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [01:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [01:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 11/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [01:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 36 u1: BPM st: NotStopd t0: [01:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [01:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [01:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [01:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [01:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [01:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [02:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [02:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [02:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [02:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [02:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [02:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 11/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [02:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [02:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 10/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml t0: [02:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [02:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [02:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [02:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [02:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 10/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -19.1 cv: -19.1 ap: none t0: [23:00:00 10/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 70.9 cv: 1588.6 ap: none t0: [23:00:00 10/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -19.1 cv: -10.4 ap: none t0: [23:00:00 10/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -19.1 cv: 9466.36 ap: carryForward
t0: [02:00:00 11/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml
t0: [23:00:00 11/01/2016] dt: 24 id: Colloids Total el: 3 cu: CSRU cg: RN cv: 250 ap: none
t0: [01:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [02:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [03:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [03:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [03:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 11/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [03:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [03:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [03:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [03:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 11/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [03:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 27 u1: BPM st: NotStopd t0: [03:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [03:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [03:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [03:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [03:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:30:00 11/01/2016] id: Blood Products Hematology el: 0 cu: CSRU cg: 3161 v1: Y rs: Final st: NotStopd
t0: [04:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [04:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [04:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 11/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 67 u1: BPM st: NotStopd t0: [04:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [04:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [04:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [04:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 11/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [04:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [04:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [04:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [04:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [04:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [04:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [04:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:00:00 11/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [04:00:00 11/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [04:00:00 11/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 11/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [04:00:00 11/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 11/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 11/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 11/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 11/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 11/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8.5 st: NotStopd t0: [04:00:00 11/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 11/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 11/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [04:00:00 11/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 9.3 u1: L/min st: NotStopd t0: [04:00:00 11/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [04:00:00 11/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 11/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 44 u1: cmH2O st: NotStopd t0: [04:00:00 11/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 11/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 11/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 11/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 2 u1: cmH2O st: NotStopd t0: [04:00:00 11/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [04:00:00 11/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 3 st: NotStopd t0: [04:00:00 11/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 11/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [04:00:00 11/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [04:00:00 11/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [04:00:00 11/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [04:00:00 11/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd
t0: [05:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [05:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [05:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [05:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [05:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [05:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [05:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 11/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [05:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [05:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 97 u1: % st: NotStopd t0: [05:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [05:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [05:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [05:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [05:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [05:00:00 11/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 11/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [05:00:00 11/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.5 u1: Deg. C st: NotStopd t0: [05:00:00 11/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 99.5 u1: Deg. F st: NotStopd
t0: [05:00:00 11/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 45 vu: ml
t0: [05:42:00 11/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.34 rs: Final st: NotStopd t0: [05:42:00 11/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 0 rs: Final st: NotStopd t0: [05:42:00 11/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 29 rs: Final st: NotStopd t0: [05:42:00 11/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 52 u1: mmHg rs: Final st: NotStopd t0: [05:42:00 11/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 105 u1: mmHg rs: Final st: NotStopd t0: [05:42:00 11/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.34 rs: Final st: NotStopd
t0: [06:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [06:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [06:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 11/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [06:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [06:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [06:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [06:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 11/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [06:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 10 u1: BPM st: NotStopd t0: [06:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [06:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:19:00 11/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 8.7 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 8.7 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 32.3 u1: % rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.8 u1: gm/dl rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 192 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.48 u1: /mic l rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 8.7 rs: Final st: NotStopd
t0: [06:19:00 11/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.9 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 35.1 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.9 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 35.1 rs: Final st: NotStopd
t0: [06:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [06:00:00 11/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml t0: [06:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [06:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [06:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [00:00:00 11/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 11/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 11/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 11/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 11/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 11/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 11/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 11/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 11/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 11/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 11/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [00:00:00 11/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 11/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 11/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 11/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [00:00:00 11/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 11/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 11/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 11/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 11/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [00:00:00 11/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [00:00:00 11/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 11/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Yellow v2: Large st: NotStopd t0: [00:00:00 11/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 11/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [00:00:00 11/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Purple st: NotStopd t0: [00:00:00 11/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 11/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [00:00:00 11/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [00:00:00 11/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated st: NotStopd t0: [00:00:00 11/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 11/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 11/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 11/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 11/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 11/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 11/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 11/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 11/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 11/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 11/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 11/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 11/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [00:00:00 11/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 11/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 11/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 11/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 11/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 11/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 11/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 11/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 11/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 11/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 11/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 11/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 11/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 11/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 11/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [00:00:00 11/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 11/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Problem st: NotStopd t0: [00:00:00 11/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 11/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Moist st: NotStopd t0: [00:00:00 11/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 11/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 10 u1: number st: NotStopd t0: [00:00:00 11/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 11/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 11/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 11/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 11/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 11/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 11/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [00:00:00 11/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [02:00:00 11/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [04:00:00 11/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 11/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 11/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 11/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 11/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 11/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [04:00:00 11/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [04:00:00 11/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 11/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 11/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 11/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [05:00:00 11/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 11/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [05:00:00 11/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 11/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [05:00:00 11/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 11/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 11/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [06:00:00 11/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 11/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd
t0: [05:00:00 11/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 11/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [05:00:00 11/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [05:00:00 11/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [05:00:00 11/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [05:00:00 11/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [05:00:00 11/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [05:00:00 11/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [05:00:00 11/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 11/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [05:00:00 11/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [05:00:00 11/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [05:00:00 11/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [05:00:00 11/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 11/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 11/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [05:00:00 11/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 11/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 11/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [05:00:00 11/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [05:00:00 11/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 11/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [05:00:00 11/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [05:00:00 11/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 11/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 11/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [05:00:00 11/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [05:00:00 11/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [05:00:00 11/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [05:00:00 11/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [05:00:00 11/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [05:00:00 11/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Consistently st: NotStopd t0: [05:00:00 11/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 9 u1: points st: NotStopd t0: [05:00:00 11/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [05:00:00 11/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 11/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [05:00:00 11/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 11/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [05:00:00 11/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [05:00:00 11/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd
t0: [05:00:00 11/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [05:00:00 11/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [05:00:00 11/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [05:00:00 11/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [05:00:00 11/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 11/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Yellow v2: Moderate st: NotStopd t0: [05:00:00 11/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [05:00:00 11/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [05:00:00 11/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Purple st: NotStopd t0: [05:00:00 11/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [05:00:00 11/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [05:00:00 11/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [05:00:00 11/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 11/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 11/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [05:00:00 11/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [05:00:00 11/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [05:00:00 11/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [05:00:00 11/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [05:00:00 11/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [05:00:00 11/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd
t0: [06:19:00 11/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 43 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 97 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 6.5 u1: mEq/L rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Total Bili Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: ALT Enzymes el: 0 cu: CSRU cg: 3161 v1: 15 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: AST Enzymes el: 0 cu: CSRU cg: 3161 v1: 22 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Alk. Phosphate Enzymes el: 0 cu: CSRU cg: 3161 v1: 66 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 43 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 104 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.5 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 97 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 6.5 u1: mEq/L rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd t0: [06:19:00 11/01/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.4 rs: Final st: NotStopd
t0: [07:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [07:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [07:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 11/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [07:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 101 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [07:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [07:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 11/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [07:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 30 u1: BPM st: NotStopd t0: [07:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [07:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [07:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [07:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [07:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [07:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [07:00:00 11/01/2016] id: Gastric Nasogastric el: 1 cu: CSRU cg: RN vo: 200 vu: ml
t0: [07:31:00 11/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [07:31:00 11/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [07:31:00 11/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [07:31:00 11/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [07:31:00 11/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [07:31:00 11/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [07:31:00 11/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [07:31:00 11/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:31:00 11/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:31:00 11/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8.5 st: NotStopd t0: [07:31:00 11/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:31:00 11/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:31:00 11/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [07:31:00 11/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.3 u1: L/min st: NotStopd t0: [07:31:00 11/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [07:31:00 11/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [07:31:00 11/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 44 u1: cmH2O st: NotStopd t0: [07:31:00 11/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [07:31:00 11/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [07:31:00 11/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [07:31:00 11/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [07:31:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 99 u1: % st: NotStopd t0: [07:31:00 11/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [07:31:00 11/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [07:31:00 11/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [07:31:00 11/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [07:31:00 11/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [07:31:00 11/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 380 u1: ml/B st: NotStopd t0: [07:31:00 11/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [07:31:00 11/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [07:31:00 11/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [07:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25
t0: [08:00:00 11/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 11/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 11/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 11/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 11/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 11/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 11/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 11/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Change in Vitals st: NotStopd t0: [08:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [08:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [08:00:00 11/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 11/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 11/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 11/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 11/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 11/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 11/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [08:00:00 11/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 11/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 11/01/2016] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 11/01/2016] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [08:00:00 11/01/2016] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [08:00:00 11/01/2016] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 11/01/2016] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [08:00:00 11/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [08:00:00 11/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 11/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Consistently st: NotStopd t0: [08:00:00 11/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 9 u1: points st: NotStopd t0: [08:00:00 11/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 11/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 11/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [08:00:00 11/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 11/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [08:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 11/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 11/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 11/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 11/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 11/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 11/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 11/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 11/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 11/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [08:00:00 11/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 11/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 11/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 11/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [08:00:00 11/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [08:00:00 11/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 11/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [08:00:00 11/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 11/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 11/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 11/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 11/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 11/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 11/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 11/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [08:00:00 11/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [08:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [08:00:00 11/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 11/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 11/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 68.3 u1: kg st: NotStopd t0: [08:00:00 11/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [08:00:00 11/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [08:00:00 11/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 11/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 11/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 11/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 11/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 35 u1: BPM st: NotStopd t0: [08:00:00 11/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 11/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 11/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 11/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 11/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 11/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 11/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 11/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 11/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [08:00:00 11/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 11/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 11/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 11/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 11/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 11/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [08:00:00 11/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [08:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [08:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [08:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [08:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml t0: [08:00:00 11/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 35 vu: ml
t0: [08:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [09:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [09:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [09:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [09:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [09:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 122 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [09:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [09:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 32 u1: BPM st: NotStopd t0: [09:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [09:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [09:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [09:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [09:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [09:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [10:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [10:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 11/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [10:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [10:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [10:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [10:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [10:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 126 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [10:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [10:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [10:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [10:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 11/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 85 vu: ml t0: [10:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [10:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [10:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [10:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml t0: [10:00:00 11/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 20 vu: ml
t0: [10:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 11/01/2016] dt: 24 id: PO/Gastric In Total el: 3 cu: CSRU cg: RN cv: 85 ap: none
t0: [12:00:00 11/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 12 t0: [12:00:00 11/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [12:00:00 11/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 11/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [12:00:00 11/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:00:00 11/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 11/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 11/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 11/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 11/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8.5 st: NotStopd t0: [12:00:00 11/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 11/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 11/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [12:00:00 11/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 11.8 u1: L/min st: NotStopd t0: [12:00:00 11/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [12:00:00 11/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 11/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 44 u1: cmH2O st: NotStopd t0: [12:00:00 11/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [12:00:00 11/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [12:00:00 11/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [12:00:00 11/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:00:00 11/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [12:00:00 11/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [12:00:00 11/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [12:00:00 11/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [12:00:00 11/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [12:00:00 11/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 380 u1: ml/B st: NotStopd t0: [12:00:00 11/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [12:00:00 11/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 11/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [12:00:00 11/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 11/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 11/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [12:00:00 11/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 11/01/2016] id: Pain Present el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [12:00:00 11/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Not Done st: NotStopd t0: [12:00:00 11/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 11/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Non-verbal cues st: NotStopd t0: [12:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [12:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [12:00:00 11/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 11/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 11/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 11/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 11/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 11/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 11/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [12:00:00 11/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [12:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 11/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [12:00:00 11/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 11/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 11/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [12:00:00 11/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 11/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Consistently st: NotStopd t0: [12:00:00 11/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 10 u1: points st: NotStopd t0: [12:00:00 11/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 11/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [12:00:00 11/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [12:00:00 11/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 11/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [12:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 11/01/2016] id: Height of Bed el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 11/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [12:00:00 11/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [12:00:00 11/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Fling st: NotStopd t0: [12:00:00 11/01/2016] id: INV#2 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [12:00:00 11/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [12:00:00 11/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Yellow v2: Moderate st: NotStopd t0: [12:00:00 11/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [12:00:00 11/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 11/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [12:00:00 11/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 11/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 11/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 11/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 11/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 11/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 11/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 11/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 11/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 11/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 11/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 114 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [12:00:00 11/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [12:00:00 11/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 11/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 134 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [12:00:00 11/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [12:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [12:00:00 11/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Not Done st: NotStopd t0: [12:00:00 11/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [12:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [12:00:00 11/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [12:00:00 11/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [12:00:00 11/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 11/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 11/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 11/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Not Done st: NotStopd t0: [12:00:00 11/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [12:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 31 u1: BPM st: NotStopd t0: [12:00:00 11/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 11/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 11/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 11/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 11/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 11/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 11/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [12:00:00 11/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.9444 u1: Deg. C st: NotStopd t0: [12:00:00 11/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.5 u1: Deg. F st: NotStopd t0: [12:00:00 11/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 11/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 11/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 11/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 11/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [12:00:00 11/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [12:00:00 11/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Problem st: NotStopd t0: [12:00:00 11/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [12:00:00 11/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [12:00:00 11/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [12:00:00 11/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 11 u1: number st: NotStopd t0: [12:00:00 11/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [12:00:00 11/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 11/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 11/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 11/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 11/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [12:00:00 11/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Negative st: NotStopd t0: [12:00:00 11/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Sanguinous st: NotStopd
t0: [12:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 84 vu: ml t0: [12:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [12:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 20 vu: ml t0: [12:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 7 vu: ml t0: [12:00:00 11/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 20 vu: ml
t0: [12:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:30:00 11/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml
t0: [12:00:00 11/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [12:00:00 11/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [12:00:00 11/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Purple st: NotStopd t0: [13:00:00 11/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 11/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 11/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 11/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 11/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [13:00:00 11/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:00:00 11/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd
t0: [13:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [13:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [13:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [13:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [13:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [13:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [13:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 128 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [13:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [13:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [13:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 38 u1: BPM st: NotStopd t0: [13:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [13:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [13:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [13:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [13:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [13:00:00 11/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd
pt: TPN
t0: [14:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [14:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [14:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [14:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [14:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [14:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [14:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 137 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [14:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [14:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [14:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 39 u1: BPM st: NotStopd t0: [14:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [15:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [15:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [15:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [15:00:00 11/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [15:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [15:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 129 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [15:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [15:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [15:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [15:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 84 vu: ml t0: [15:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [15:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 20 vu: ml t0: [15:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 7 vu: ml t0: [15:00:00 11/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 18 vu: ml
t0: [15:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [16:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [16:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [16:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [16:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [16:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [16:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN t0: [16:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 116 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [16:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [16:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 33 u1: BPM st: NotStopd t0: [16:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 11/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [16:00:00 11/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [16:00:00 11/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [16:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 42 vu: ml t0: [16:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [16:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [16:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [16:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 du: mcghr sv: 50 su: ml rt: IV Drip st: Stopped t0: [16:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 du: mghr sv: 50 su: ml rt: IV Drip st: Stopped
t0: [16:00:00 11/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml
t0: [16:15:00 11/01/2016] id: Significant Events el: 0 cu: CSRU cg: RN v1: OR Sent st: NotStopd
t0: [16:00:00 11/01/2016] id: Gastric Nasogastric el: 1 cu: CSRU cg: RN vo: 50 vu: ml
t0: [23:00:00 11/01/2016] dt: 24 id: Gastric Out Total el: 3 cu: CSRU cg: RN cv: 250 ap: none
t0: [17:00:00 11/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.48 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 82 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.4 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 3 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 26 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 34 u1: mmHg rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 480 u1: mmHg rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.48 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 82 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 32 u1: % rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.06 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.2 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.4 rs: Final st: NotStopd t0: [17:00:00 11/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd
t0: [18:10:00 11/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 83 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 2 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 41 u1: mmHg rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 446 u1: mmHg rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.42 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 83 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 33 u1: % rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Ionized Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.22 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 142 rs: Final st: NotStopd
t0: [18:10:00 11/01/2016] id: Lactic Acid Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd t0: [18:10:00 11/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.3 rs: Final st: NotStopd
t0: [18:00:00 11/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 15 t0: [18:00:00 11/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [18:00:00 11/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [18:00:00 11/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [18:00:00 11/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [18:00:00 11/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [18:00:00 11/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [18:00:00 11/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [18:00:00 11/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [18:00:00 11/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8.5 st: NotStopd t0: [18:00:00 11/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [18:00:00 11/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [18:00:00 11/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [18:00:00 11/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 13.2 u1: L/min st: NotStopd t0: [18:00:00 11/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [18:00:00 11/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [18:00:00 11/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 43 u1: cmH2O st: NotStopd t0: [18:00:00 11/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [18:00:00 11/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [18:00:00 11/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [18:00:00 11/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [18:00:00 11/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [18:00:00 11/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [18:00:00 11/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [18:00:00 11/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [18:00:00 11/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [18:00:00 11/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 390 u1: ml/B st: NotStopd t0: [18:00:00 11/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [18:00:00 11/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [18:00:00 11/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
id: OR Crystalloid el: 2 cu: CSRU cg: RN io: OR Crystalloid OR Intake du: ml rt: Intravenous Push
t0: [18:45:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [18:45:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [18:45:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [18:45:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [18:45:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 79 u1: BPM st: NotStopd t0: [18:45:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [18:45:00 11/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 113 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [18:45:00 11/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 85.6667 u1: mmHg st: NotStopd t0: [18:45:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 146 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [18:45:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [18:45:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [18:45:00 11/01/2016] id: Significant Events el: 0 cu: CSRU cg: RN v1: OR Received st: NotStopd t0: [18:45:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [18:45:00 11/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [18:45:00 11/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.1667 u1: Deg. C st: NotStopd t0: [18:45:00 11/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97.1 u1: Deg. F st: NotStopd t0: [18:45:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [19:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [19:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [19:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [19:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [19:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [19:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [19:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [19:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 11/01/2016] tf: [09:53:00 12/01/2016] dt: 893 id: OR Crystalloid OR Intake el: 2 cu: CSRU cg: RN ai: 124 vo: 600 vu: ml t0: [19:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 15 vu: ml t0: [19:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 126 vu: ml t0: [19:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [19:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 30 vu: ml t0: [19:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 10.5 vu: ml t0: [19:00:00 11/01/2016] tf: [09:53:00 12/01/2016] dt: 893 id: OR Out OR Urine el: 1 cu: CSRU cg: RN vo: 100 vu: ml t0: [19:00:00 11/01/2016] tf: [09:53:00 12/01/2016] dt: 893 id: OR Out EBL el: 1 cu: CSRU cg: RN vo: 150 vu: ml t0: [19:00:00 11/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 19 vu: ml
t0: [19:00:00 11/01/2016] tf: [09:53:00 12/01/2016] dt: 893 id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 11/01/2016] tf: [09:53:00 12/01/2016] dt: 893 id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [19:30:00 11/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.46 rs: Final st: NotStopd t0: [19:30:00 11/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 3 rs: Final st: NotStopd t0: [19:30:00 11/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [19:30:00 11/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 38 u1: mmHg rs: Final st: NotStopd t0: [19:30:00 11/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 175 u1: mmHg rs: Final st: NotStopd t0: [19:30:00 11/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.46 rs: Final st: NotStopd
t0: [19:45:00 11/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 15 t0: [19:45:00 11/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [19:45:00 11/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [19:45:00 11/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [19:45:00 11/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [19:45:00 11/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [19:45:00 11/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [19:45:00 11/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [19:45:00 11/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [19:45:00 11/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8.5 st: NotStopd t0: [19:45:00 11/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [19:45:00 11/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [19:45:00 11/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [19:45:00 11/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 13.3 u1: L/min st: NotStopd t0: [19:45:00 11/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [19:45:00 11/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [19:45:00 11/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 43 u1: cmH2O st: NotStopd t0: [19:45:00 11/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [19:45:00 11/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [19:45:00 11/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [19:45:00 11/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [19:45:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [19:45:00 11/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [19:45:00 11/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [19:45:00 11/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [19:45:00 11/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [19:45:00 11/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [19:45:00 11/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 387 u1: ml/B st: NotStopd t0: [19:45:00 11/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [19:45:00 11/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [19:45:00 11/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [19:25:00 11/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 9.6 rs: Final st: NotStopd t0: [19:25:00 11/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 9.6 rs: Final st: NotStopd t0: [19:25:00 11/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 32.3 u1: % rs: Final st: NotStopd t0: [19:25:00 11/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.5 u1: gm/dl rs: Final st: NotStopd t0: [19:25:00 11/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 207 rs: Final st: NotStopd t0: [19:25:00 11/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.55 u1: /mic l rs: Final st: NotStopd t0: [19:25:00 11/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 9.6 rs: Final st: NotStopd
t0: [20:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [20:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [20:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 11/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [20:00:00 11/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 69 u1: BPM st: NotStopd t0: [20:00:00 11/01/2016] id: NBP el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [20:00:00 11/01/2016] id: NBP Mean el: 0 cu: CSRU cg: RN v1: 86.3333 u1: mmHg st: NotStopd t0: [20:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 144 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [20:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [20:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [20:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [20:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [20:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [20:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 11/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [20:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25
t0: [20:00:00 11/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 11/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [20:00:00 11/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [20:00:00 11/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 97 u1: Deg. F st: NotStopd
t0: [21:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [21:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [21:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [21:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [21:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 136 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [21:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [21:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [21:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [21:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [21:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [21:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [21:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [21:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25
t0: [21:00:00 11/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [21:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [22:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [22:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [22:00:00 11/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [22:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 66 u1: BPM st: NotStopd t0: [22:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [22:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 150 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [22:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 109 u1: mmHg st: NotStopd t0: [22:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [22:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 43 u1: BPM st: NotStopd t0: [22:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [22:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [22:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [22:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 11/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 28 u1: cmH2O st: NotStopd
t0: [22:00:00 11/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [23:00:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:00:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 44 u1: mmHg st: NotStopd t0: [23:00:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:00:00 11/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 11/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [23:00:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 68 u1: BPM st: NotStopd t0: [23:00:00 11/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [23:00:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 155 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [23:00:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg st: NotStopd t0: [23:00:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:00:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 34 u1: BPM st: NotStopd t0: [23:00:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 11/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 11/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [23:00:00 11/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 10 vu: ml t0: [23:00:00 11/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [23:00:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 11/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: CSRU cg: RN pv: 180 cv: 180 ap: none t0: [23:00:00 11/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: CSRU cg: RN pv: 18.5 cv: 444 ap: none t0: [23:00:00 11/01/2016] dt: 24 id: IV Nutrition Total el: 3 cu: CSRU cg: RN pv: 42 cv: 1008 ap: none t0: [23:00:00 11/01/2016] dt: 24 id: Urine Out Total el: 3 cu: CSRU cg: RN pv: 180 cv: 2465 ap: none t0: [23:00:00 11/01/2016] dt: 24 id: 24h Total Out el: 3 cu: CSRU cg: RN pv: 180 cv: 3282 ap: none
t0: [20:00:00 11/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 11/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Positive st: NotStopd t0: [20:00:00 11/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 11/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 11/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 11/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 11/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 11/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 11/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 11/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [20:00:00 11/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 11/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 11/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [20:00:00 11/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 11/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 3 u1: points st: NotStopd t0: [20:00:00 11/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 11/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Clear st: NotStopd t0: [20:00:00 11/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 11/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 11/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 11/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 11/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [20:00:00 11/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 11/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [20:00:00 11/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 11/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 11/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 11/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [20:00:00 11/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 11/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 11/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 11/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 11/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 11/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [20:00:00 11/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 11/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Yellow v2: Large st: NotStopd t0: [20:00:00 11/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 11/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [20:00:00 11/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Purple st: NotStopd t0: [20:00:00 11/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 11/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [20:00:00 11/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [20:00:00 11/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated st: NotStopd t0: [20:00:00 11/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 11/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 11/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [20:00:00 11/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 11/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 11/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 11/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Exp Wheeze st: NotStopd t0: [20:00:00 11/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 11/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 11/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 11/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 11/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 11/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt v2: IV Gtt st: NotStopd t0: [20:00:00 11/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Supine st: NotStopd t0: [20:00:00 11/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/01/2016] id: PostTib. Pulses R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 11/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 11/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [20:00:00 11/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Clear st: NotStopd t0: [20:00:00 11/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 11/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 11/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [20:00:00 11/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [20:00:00 11/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 11/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 11/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 11/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 11/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 11/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 11/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Back st: NotStopd t0: [20:00:00 11/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 11/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 11/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 11/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 11/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [20:00:00 11/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Positive st: NotStopd t0: [20:00:00 11/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 11/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 11/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Positive st: NotStopd t0: [20:00:00 11/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 11/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Positive st: NotStopd t0: [20:00:00 11/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [23:07:00 11/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.49 rs: Final st: NotStopd t0: [23:07:00 11/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 5 rs: Final st: NotStopd t0: [23:07:00 11/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 29 rs: Final st: NotStopd t0: [23:07:00 11/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 37 u1: mmHg rs: Final st: NotStopd t0: [23:07:00 11/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 197 u1: mmHg rs: Final st: NotStopd t0: [23:07:00 11/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.49 rs: Final st: NotStopd t0: [23:15:00 11/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [23:15:00 11/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [23:15:00 11/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [23:15:00 11/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [23:15:00 11/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 70 u1: BPM st: NotStopd t0: [23:15:00 11/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [23:15:00 11/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 149 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [23:15:00 11/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 107 u1: mmHg st: NotStopd t0: [23:15:00 11/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [23:15:00 11/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 46 u1: BPM st: NotStopd t0: [23:15:00 11/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [23:15:00 11/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:15:00 11/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:15:00 11/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 11/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [23:00:00 11/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 320 u1: ml/B st: NotStopd
t0: [22:00:00 11/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml t0: [00:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 12/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [00:00:00 12/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 11.875 vu: ml t0: [00:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [23:00:00 11/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: CSRU cg: RN pv: -109.1 cv: -109.1 ap: none t0: [23:00:00 11/01/2016] dt: 24 id: 24h Total In el: 3 cu: CSRU cg: RN pv: 70.9 cv: 2595 ap: none t0: [23:00:00 11/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: CSRU cg: RN pv: -109.1 cv: -687 ap: none t0: [23:00:00 11/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: CSRU cg: RN pv: -109.1 cv: 8779.37 ap: carryForward
t0: [00:00:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [00:00:00 12/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [00:00:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [00:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 142 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [00:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [00:00:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 55 u1: BPM st: NotStopd t0: [00:00:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:15:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [00:15:00 12/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [00:15:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [00:15:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [00:15:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:15:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 72 u1: BPM st: NotStopd t0: [00:15:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [00:15:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 138 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [00:15:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [00:15:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [00:15:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 39 u1: BPM st: NotStopd t0: [00:15:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [00:15:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:15:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:15:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [01:00:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [01:00:00 12/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [01:00:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [01:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [01:00:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [01:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 134 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [01:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [01:00:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [01:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 43 u1: BPM st: NotStopd t0: [01:00:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 12/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml t0: [01:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 12/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [01:00:00 12/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 14.375 vu: ml t0: [01:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [01:00:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 3.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [01:00:00 12/01/2016] tf: [04:00:00 12/01/2016] dt: 180 id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 45 vu: ml
t0: [23:00:00 12/01/2016] dt: 24 id: Chest Tube Out Total el: 3 cu: CSRU cg: RN cv: 155 ap: none
t0: [01:31:00 12/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.45 rs: Final st: NotStopd t0: [01:31:00 12/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 118 rs: Final st: NotStopd t0: [01:31:00 12/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 3 rs: Final st: NotStopd t0: [01:31:00 12/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 27 rs: Final st: NotStopd t0: [01:31:00 12/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 38 u1: mmHg rs: Final st: NotStopd t0: [01:31:00 12/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 176 u1: mmHg rs: Final st: NotStopd t0: [01:31:00 12/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.45 rs: Final st: NotStopd t0: [01:31:00 12/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 118 rs: Final st: NotStopd
t0: [01:30:00 12/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 15 t0: [01:30:00 12/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [01:30:00 12/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [01:30:00 12/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [01:30:00 12/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [01:30:00 12/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [01:30:00 12/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [01:30:00 12/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:30:00 12/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:30:00 12/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8.5 st: NotStopd t0: [01:30:00 12/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [01:30:00 12/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [01:30:00 12/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [01:30:00 12/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 13.3 u1: L/min st: NotStopd t0: [01:30:00 12/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [01:30:00 12/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [01:30:00 12/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [01:30:00 12/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [01:30:00 12/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [01:30:00 12/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [01:30:00 12/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [01:30:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [01:30:00 12/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [01:30:00 12/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [01:30:00 12/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [01:30:00 12/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [01:30:00 12/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 18 st: NotStopd t0: [01:30:00 12/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [01:30:00 12/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [01:30:00 12/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [01:30:00 12/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [00:00:00 12/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [01:00:00 12/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.25 t0: [02:00:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [02:00:00 12/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [02:00:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [02:00:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [02:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 12/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.2 t0: [02:00:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 124 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [02:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [02:00:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [02:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 36 u1: BPM st: NotStopd t0: [02:00:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 12/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [02:00:00 12/01/2016] id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 416 vo: 15 vu: ml t0: [02:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 3.5 vu: ml
t0: [02:00:00 12/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [02:00:00 12/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [02:00:00 12/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [02:00:00 12/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.2778 u1: Deg. C st: NotStopd t0: [02:00:00 12/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 99.1 u1: Deg. F st: NotStopd
id: Fentanyl el: 101 cu: CCU cg: RN io: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions am: 2500 du: mcghr rt: IV Drip id: Fentanyl el: 201 cu: CSRU cg: RN io: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions am: 2500 du: mcghr rt: IV Drip
io: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ra: 4 ru: ml/hr io: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ra: 4 ru: ml/hr
id: .9% Normal Saline el: 1 cu: CCU cg: RN io: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions vo: 50 du: ml rt: Intravenous Push id: .9% Normal Saline el: 2 cu: CSRU cg: RN io: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions vo: 50 du: ml rt: Intravenous Push
t0: [03:00:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [03:00:00 12/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [03:00:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [03:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [03:00:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [03:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 12/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.2 t0: [03:00:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 122 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [03:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [03:00:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [03:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 42 u1: BPM st: NotStopd t0: [03:00:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 12/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [03:00:00 12/01/2016] tf: [09:53:00 12/01/2016] dt: 413 id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 20 vu: ml t0: [03:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml
t0: [04:00:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [04:00:00 12/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [04:00:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [04:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [04:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 120 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [04:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [04:00:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [04:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 37 u1: BPM st: NotStopd t0: [04:00:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 12/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml t0: [04:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 12/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [04:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 4 vu: ml t0: [04:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml t0: [04:00:00 12/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [04:51:00 12/01/2016] id: Art.pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.48 rs: Final st: NotStopd t0: [04:51:00 12/01/2016] id: Arterial Base Excess ABG el: 0 cu: CSRU cg: 3161 v1: 6 rs: Final st: NotStopd t0: [04:51:00 12/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CSRU cg: 3161 v1: 30 rs: Final st: NotStopd t0: [04:51:00 12/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CSRU cg: 3161 v1: 39 u1: mmHg rs: Final st: NotStopd t0: [04:51:00 12/01/2016] id: Arterial PaO2 ABG el: 0 cu: CSRU cg: 3161 v1: 174 u1: mmHg rs: Final st: NotStopd t0: [04:51:00 12/01/2016] id: Arterial pH ABG el: 0 cu: CSRU cg: 3161 v1: 7.48 rs: Final st: NotStopd
t0: [05:00:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [05:00:00 12/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [05:00:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [05:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [05:00:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 76 u1: BPM st: NotStopd t0: [05:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 118 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [05:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [05:00:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [05:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 40 u1: BPM st: NotStopd t0: [05:00:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 12/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [05:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 4 vu: ml t0: [05:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml
t0: [05:00:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:56:00 12/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 9 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: WBC Hematology el: 0 cu: CSRU cg: 3161 v1: 9 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Hematocrit Hematology el: 0 cu: CSRU cg: 3161 v1: 32.6 u1: % rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Hemoglobin Hematology el: 0 cu: CSRU cg: 3161 v1: 10.5 u1: gm/dl rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Platelets Hematology el: 0 cu: CSRU cg: 3161 v1: 222 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: RBC Hematology el: 0 cu: CSRU cg: 3161 v1: 3.56 u1: /mic l rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CSRU cg: 3161 v1: 9 rs: Final st: NotStopd
t0: [20:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [21:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [22:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [23:00:00 11/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [00:00:00 12/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [01:00:00 12/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [02:00:00 12/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [03:00:00 12/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [04:00:00 12/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [05:00:00 12/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml
t0: [04:56:00 12/01/2016] id: BUN el: 0 cu: CSRU cg: 3161 v1: 48 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Albumin Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.9 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Calcium Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.6 u1: mg/dl rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Chloride Chemistry el: 0 cu: CSRU cg: 3161 v1: 106 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Creatinine Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.3 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Glucose Chemistry el: 0 cu: CSRU cg: 3161 v1: 112 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Magnesium Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Phosphorous Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.9 u1: mEq/L rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Potassium Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Sodium Chemistry el: 0 cu: CSRU cg: 3161 v1: 143 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Albumin (>3.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.9 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CSRU cg: 3161 v1: 48 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CSRU cg: 3161 v1: 8.6 u1: mg/dl rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CSRU cg: 3161 v1: 28 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CSRU cg: 3161 v1: 106 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 2.3 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CSRU cg: 3161 v1: 112 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CSRU cg: 3161 v1: 1.9 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CSRU cg: 3161 v1: 4.9 u1: mEq/L rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CSRU cg: 3161 v1: 3.6 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CSRU cg: 3161 v1: 143 rs: Final st: NotStopd
t0: [06:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 12/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [06:00:00 12/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [06:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 4 vu: ml t0: [06:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml t0: [06:00:00 12/01/2016] tf: [08:00:00 12/01/2016] dt: 120 id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 40 vu: ml
t0: [04:00:00 12/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.2 t0: [05:00:00 12/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.2 t0: [06:00:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [06:00:00 12/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [06:00:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [06:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [06:00:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 77 u1: BPM st: NotStopd t0: [06:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 12/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.2 t0: [06:00:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 123 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [06:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [06:00:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [06:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 24 u1: BPM st: NotStopd t0: [06:00:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:00:00 12/01/2016] id: RSBI Not Completed el: 0 cu: CSRU cg: RRT v1: PEEP >10 st: NotStopd t0: [06:00:00 12/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 15 t0: [06:00:00 12/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 27cm v2: Lip st: NotStopd t0: [06:00:00 12/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [06:00:00 12/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [06:00:00 12/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [06:00:00 12/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [06:00:00 12/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [06:00:00 12/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [06:00:00 12/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [06:00:00 12/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8.5 st: NotStopd t0: [06:00:00 12/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [06:00:00 12/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CSRU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [06:00:00 12/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [06:00:00 12/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 13.2 u1: L/min st: NotStopd t0: [06:00:00 12/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [06:00:00 12/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [06:00:00 12/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [06:00:00 12/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [06:00:00 12/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [06:00:00 12/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [06:00:00 12/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [06:00:00 12/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [06:00:00 12/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [06:00:00 12/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [06:00:00 12/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [06:00:00 12/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 5 u1: sec st: NotStopd t0: [06:00:00 12/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 19 st: NotStopd t0: [06:00:00 12/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [06:00:00 12/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [06:00:00 12/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [06:00:00 12/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: SQUARE st: NotStopd
t0: [04:56:00 12/01/2016] id: PT el: 0 cu: CSRU cg: 3161 v1: 14.9 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: INR Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: PTT Coags el: 0 cu: CSRU cg: 3161 v1: 35.1 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CSRU cg: 3161 v1: 1.5 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: PT(11-13.5) Coags el: 0 cu: CSRU cg: 3161 v1: 14.9 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] id: PTT(22-35) Coags el: 0 cu: CSRU cg: 3161 v1: 35.1 rs: Final st: NotStopd
t0: [06:00:00 12/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Axillary st: NotStopd t0: [06:00:00 12/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [06:00:00 12/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 98.7 u1: Deg. F st: NotStopd
t0: [06:00:00 12/01/2016] id: Sputum Color/Consist el: 0 cu: CSRU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [06:00:00 12/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RN v1: Suctioned v2: Small st: NotStopd
t0: [00:00:00 12/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 12/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Positive st: NotStopd t0: [00:00:00 12/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 12/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 12/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 12/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 12/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [00:00:00 12/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CSRU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 12/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 12/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [00:00:00 12/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 2 To pain st: NotStopd t0: [00:00:00 12/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Consistently st: NotStopd t0: [00:00:00 12/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 8 u1: points st: NotStopd t0: [00:00:00 12/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 12/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [00:00:00 12/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [00:00:00 12/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 12/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 12/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 12/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [00:00:00 12/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [00:00:00 12/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 12/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Serous v2: Large st: NotStopd t0: [00:00:00 12/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 12/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [00:00:00 12/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Purple st: NotStopd t0: [00:00:00 12/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 12/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [00:00:00 12/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [00:00:00 12/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated st: NotStopd t0: [00:00:00 12/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 12/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 12/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [00:00:00 12/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 12/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 12/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 12/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 12/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 12/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 12/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 12/01/2016] id: Orientation el: 0 cu: CSRU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 12/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 12/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [00:00:00 12/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 12/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 12/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 12/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [00:00:00 12/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 12/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 12/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 12/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 12/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 12/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 12/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 12/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 12/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 12/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [00:00:00 12/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 12/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Problem st: NotStopd t0: [00:00:00 12/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Comp. Immobile st: NotStopd t0: [00:00:00 12/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 12/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Very Poor st: NotStopd t0: [00:00:00 12/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 9 u1: number st: NotStopd t0: [00:00:00 12/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 12/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Positive st: NotStopd t0: [00:00:00 12/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [00:00:00 12/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 12/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Positive st: NotStopd t0: [00:00:00 12/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 12/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Positive st: NotStopd t0: [00:00:00 12/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [00:00:00 12/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 12/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 12/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Fair st: NotStopd t0: [00:00:00 12/01/2016] id: AntiEmbDevice/Status el: 0 cu: CSRU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 12/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 12/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 12/01/2016] id: PressureReduceDevice el: 0 cu: CSRU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 12/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 12/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 12/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: Plan of Care st: NotStopd t0: [04:00:00 12/01/2016] id: ImpSkin Character #1 el: 0 cu: CSRU cg: RN v1: Abrasion st: NotStopd t0: [04:00:00 12/01/2016] id: ImpSkin Character #2 el: 0 cu: CSRU cg: RN v1: Blister st: NotStopd t0: [04:00:00 12/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 12/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CSRU cg: RN v1: Serous v2: Large st: NotStopd t0: [04:00:00 12/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CSRU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 12/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CSRU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [04:00:00 12/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CSRU cg: RN v1: Purple st: NotStopd t0: [04:00:00 12/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 12/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [04:00:00 12/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CSRU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [04:00:00 12/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CSRU cg: RN v1: Approximated st: NotStopd t0: [04:00:00 12/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 12/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [04:00:00 12/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 12/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 12/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 12/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [04:00:00 12/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 12/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 12/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 12/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 12/01/2016] id: Behavior el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 12/01/2016] id: Eye Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 12/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 45 degrees st: NotStopd t0: [05:00:00 12/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 12/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [05:00:00 12/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 12/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 12/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [05:00:00 12/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Left Side st: NotStopd t0: [05:00:00 12/01/2016] id: Back Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd
t0: [00:00:00 12/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 12/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 12/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 12/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 12/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 12/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 12/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [00:00:00 12/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [00:00:00 12/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 12/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [04:00:00 12/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 12/01/2016] id: Pain Assess Method el: 0 cu: CSRU cg: RN v1: Grimace Scale st: NotStopd t0: [04:00:00 12/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 12/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 12/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 12/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 12/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 12/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [04:00:00 12/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [04:00:00 12/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 12/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd
t0: [07:00:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [07:00:00 12/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [07:00:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [07:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [07:00:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 75 u1: BPM st: NotStopd t0: [07:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 111 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [07:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [07:00:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [07:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 46 u1: BPM st: NotStopd t0: [07:00:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 12/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: CSRU cg: RN ai: -1 vo: 50 vu: ml t0: [07:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 12/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [07:00:00 12/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [07:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 4 vu: ml t0: [07:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml
t0: [07:00:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 12/01/2016] dt: 24 id: Colloids Total el: 3 cu: -1 cg: RN cv: 100 ap: none
t0: [07:00:00 12/01/2016] id: BUMEX MG/HR el: 0 cu: CSRU cg: RN v1: 0.2
t0: [08:00:00 12/01/2016] id: CT #2 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 12/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Positive st: NotStopd t0: [08:00:00 12/01/2016] id: CT #2 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 12/01/2016] id: Less Restrict Meas. el: 0 cu: CSRU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 12/01/2016] id: Range of Motion el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 12/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [08:00:00 12/01/2016] id: CVP el: 0 cu: CSRU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [08:00:00 12/01/2016] id: Chest Tube Site #1 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 12/01/2016] id: Chest Tube Site #2 el: 0 cu: CSRU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 12/01/2016] id: Circulation/SkinInt el: 0 cu: CSRU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 12/01/2016] id: Riker-SAS Scale el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 12/01/2016] id: Daily Wake Up el: 1 cu: CSRU cg: RN v1: No/O2 Issues st: NotStopd t0: [08:00:00 12/01/2016] id: GI Prophylaxis el: 0 cu: CSRU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 12/01/2016] id: Diet Type el: 0 cu: CSRU cg: RN v1: NPO st: NotStopd t0: [08:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [08:00:00 12/01/2016] id: Alarms el: 0 cu: CSRU cg: RN v1: ON st: NotStopd t0: [08:00:00 12/01/2016] id: Parameters Checked el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [08:00:00 12/01/2016] id: Edema Location/Amt#1 el: 0 cu: CSRU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 12/01/2016] id: Education Barrier el: 0 cu: CSRU cg: RN v1: Altered LOC st: NotStopd t0: [08:00:00 12/01/2016] id: Education Learner el: 0 cu: CSRU cg: RN v1: Patient st: NotStopd t0: [08:00:00 12/01/2016] id: Education Method el: 0 cu: CSRU cg: RN v1: Explanation st: NotStopd t0: [08:00:00 12/01/2016] id: Education Readiness el: 0 cu: CSRU cg: RN v1: No st: NotStopd t0: [08:00:00 12/01/2016] id: Education Response el: 0 cu: CSRU cg: RN v1: Reinforced st: NotStopd t0: [08:00:00 12/01/2016] id: Education Topic #1 el: 0 cu: CSRU cg: RN v1: ICU Environment st: NotStopd t0: [08:00:00 12/01/2016] id: Eye Opening el: 0 cu: CSRU cg: RN v1: 2 To pain st: NotStopd t0: [08:00:00 12/01/2016] id: Follows Commands el: 0 cu: CSRU cg: RN v1: Inconsistently st: NotStopd t0: [08:00:00 12/01/2016] id: GCS Total el: 0 cu: CSRU cg: RN v1: 9 u1: points st: NotStopd t0: [08:00:00 12/01/2016] id: GI Intub #2/Site el: 0 cu: CSRU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 12/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 12/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CSRU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [08:00:00 12/01/2016] id: GU Cath Insert Date el: 0 cu: CSRU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 12/01/2016] id: GU Catheter Size el: 0 cu: CSRU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 12/01/2016] id: HOB el: 0 cu: CSRU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 73 u1: BPM st: NotStopd t0: [08:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 12/01/2016] id: INV Line#1 Type/Site el: 0 cu: CSRU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 12/01/2016] id: INV Line#1InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 12/01/2016] id: INV Line#1SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 12/01/2016] id: INV Line#2 Site Date el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 12/01/2016] id: INV Line#2 Type/Site el: 0 cu: CSRU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 12/01/2016] id: INV Line#2InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 12/01/2016] id: INV Line#2SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 12/01/2016] id: INV Line#3 Type/Site el: 0 cu: CSRU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [08:00:00 12/01/2016] id: INV Line#3InsertDate el: 0 cu: CSRU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 12/01/2016] id: INV Line#3SiteAppear el: 0 cu: CSRU cg: RN v1: WNL st: NotStopd t0: [08:00:00 12/01/2016] id: Abdominal Assessment el: 0 cu: CSRU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 12/01/2016] id: INV#1 WaveformAppear el: 0 cu: CSRU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 12/01/2016] id: Activity el: 0 cu: CSRU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 12/01/2016] id: Activity Tolerance el: 0 cu: CSRU cg: RN v1: Good st: NotStopd t0: [08:00:00 12/01/2016] id: Impaired Skin Site#1 el: 0 cu: CSRU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 12/01/2016] id: Impaired Skin Site#2 el: 0 cu: CSRU cg: RN v1: Chest st: NotStopd t0: [08:00:00 12/01/2016] id: Incision/Wound #1 el: 0 cu: CSRU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 12/01/2016] id: Incision/Wound #2 el: 0 cu: CSRU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 12/01/2016] id: LLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 12/01/2016] id: LUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 12/01/2016] id: Level of Conscious el: 0 cu: CSRU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 12/01/2016] id: Motor Response el: 0 cu: CSRU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 12/01/2016] id: Oral Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 12/01/2016] id: Oral Cavity el: 0 cu: CSRU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [08:00:00 12/01/2016] id: Pain Management el: 1 cu: CSRU cg: RN v1: IV Gtt st: NotStopd t0: [08:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [08:00:00 12/01/2016] id: Position el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 12/01/2016] id: Position Change el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 12/01/2016] id: Assistance Device el: 0 cu: CSRU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [08:00:00 12/01/2016] id: Previous Weight el: 0 cu: CSRU cg: RN v1: 66 u1: kg st: NotStopd t0: [08:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 66 u1: kg st: NotStopd t0: [08:00:00 12/01/2016] id: Pupil Response R/L el: 0 cu: CSRU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [08:00:00 12/01/2016] id: Pupil Size R/L el: 0 cu: CSRU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [08:00:00 12/01/2016] id: RLL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 12/01/2016] id: RUL Lung Sounds el: 0 cu: CSRU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 12/01/2016] id: Radiologic Study el: 0 cu: CSRU cg: RN v1: Chest Xray st: NotStopd t0: [08:00:00 12/01/2016] id: Reason For Restraint el: 0 cu: CSRU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 12/01/2016] id: Removed x 5 Mins el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 12/01/2016] id: Respiratory Pattern el: 0 cu: CSRU cg: RN v1: Regular st: NotStopd t0: [08:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 28 u1: BPM st: NotStopd t0: [08:00:00 12/01/2016] id: Restraint Location el: 0 cu: CSRU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 12/01/2016] id: Restraint Type el: 0 cu: CSRU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 12/01/2016] id: Restraints Evaluated el: 0 cu: CSRU cg: RN v1: RestraintReapply st: NotStopd t0: [08:00:00 12/01/2016] id: Side Rails el: 0 cu: CSRU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 12/01/2016] id: Skin Care el: 0 cu: CSRU cg: RN v1: Done st: NotStopd t0: [08:00:00 12/01/2016] id: Skin Integrity el: 0 cu: CSRU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 12/01/2016] id: Skin Temp/Condition el: 0 cu: CSRU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 12/01/2016] id: Support Systems el: 0 cu: CSRU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 12/01/2016] id: Temp. Site el: 0 cu: CSRU cg: RN v1: Oral st: NotStopd t0: [08:00:00 12/01/2016] id: Temperature C (calc) el: 0 cu: CSRU cg: RN v1: 37.7778 u1: Deg. C st: NotStopd t0: [08:00:00 12/01/2016] id: Temperature F el: 0 cu: CSRU cg: RN v1: 100 u1: Deg. F st: NotStopd t0: [08:00:00 12/01/2016] id: Turn el: 0 cu: CSRU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 12/01/2016] id: Urine Color/Appear el: 0 cu: CSRU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 12/01/2016] id: Urine Source el: 0 cu: CSRU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 12/01/2016] id: BSA - English el: 0 cu: CSRU cg: RN v1: 1.10547 u1: m2 st: NotStopd t0: [08:00:00 12/01/2016] id: BSA - Metric el: 0 cu: CSRU cg: RN v1: 1.29332 u1: m2 st: NotStopd t0: [08:00:00 12/01/2016] id: Verbal Response el: 0 cu: CSRU cg: RN v1: 1 No Response st: NotStopd t0: [08:00:00 12/01/2016] id: Weight Change el: 0 cu: CSRU cg: RN v1: 0 u1: kg st: NotStopd t0: [08:00:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 12/01/2016] id: Daily Weight el: 0 cu: CSRU cg: RN v1: 66 u1: kg st: NotStopd t0: [08:00:00 12/01/2016] id: Bowel Sounds el: 0 cu: CSRU cg: RN v1: Absent st: NotStopd t0: [08:00:00 12/01/2016] id: Braden Activity el: 0 cu: CSRU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 12/01/2016] id: Braden Frict/Shear el: 0 cu: CSRU cg: RN v1: Problem st: NotStopd t0: [08:00:00 12/01/2016] id: Braden Mobility el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 12/01/2016] id: Braden Moisture el: 0 cu: CSRU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 12/01/2016] id: Braden Nutrition el: 0 cu: CSRU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 12/01/2016] id: Braden Score el: 0 cu: CSRU cg: RN v1: 12 u1: number st: NotStopd t0: [08:00:00 12/01/2016] id: Braden SensoryPercep el: 0 cu: CSRU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 12/01/2016] id: CT #1 Crepitus el: 0 cu: CSRU cg: RN v1: Positive st: NotStopd t0: [08:00:00 12/01/2016] id: CT #1 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 12/01/2016] id: CT #1 Dressing el: 0 cu: CSRU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 12/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CSRU cg: RN v1: Positive v2: Positive st: NotStopd t0: [08:00:00 12/01/2016] id: CT #1 Suction Amount el: 0 cu: CSRU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 12/01/2016] id: CT #2 Crepitus el: 0 cu: CSRU cg: RN v1: Positive st: NotStopd t0: [08:00:00 12/01/2016] id: CT #2 Drainage el: 0 cu: CSRU cg: RN v1: Serosanguinous st: NotStopd
t0: [08:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 12/01/2016] id: Gastric Meds PO/Gastric el: 1 cu: CSRU cg: RN ai: 111 vo: 60 vu: ml t0: [08:00:00 12/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [08:00:00 12/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [08:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 4 vu: ml t0: [08:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml t0: [08:00:00 12/01/2016] id: Chest Tubes Left Pleural 2 el: 1 cu: CSRU cg: RN vo: 0 vu: ml
t0: [08:00:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 12/01/2016] dt: 24 id: PO/Gastric In Total el: 3 cu: -1 cg: RN cv: 60 ap: none
t0: [08:35:00 12/01/2016] id: BSA el: 1033 cu: CCU cg: -1 v1: 1.71063 u1: m2 t0: [08:35:00 12/01/2016] id: Admit Wt el: 1032 cu: CCU cg: -1 v1: 66 u1: kg t0: [08:35:00 12/01/2016] id: Allergy 1 el: 1020 cu: CCU cg: -1 t0: [08:35:00 12/01/2016] id: Diagnosis/op el: 1023 cu: CCU cg: -1 v1: CONGESTIVE HEART FAILURE;TELEMETRY t0: [08:35:00 12/01/2016] id: Service el: 1026 cu: CCU cg: -1 v1: CSU t0: [08:35:00 12/01/2016] id: Admit Ht el: 1034 cu: CCU cg: -1 v1: 59 u1: inches t0: [08:35:00 12/01/2016] id: Readmission el: 1014 cu: CCU cg: -1 t0: [08:35:00 12/01/2016] id: Marital Status el: 1006 cu: CCU cg: -1 v1: M t0: [08:35:00 12/01/2016] id: Religion el: 1000 cu: CCU cg: -1 v1: NSP t0: [08:35:00 12/01/2016] id: Allergy 2 el: 1021 cu: CCU cg: -1 t0: [08:35:00 12/01/2016] id: Ext el: 1010 cu: CCU cg: -1 t0: [08:35:00 12/01/2016] id: PIN el: 1012 cu: CCU cg: -1 t0: [08:35:00 12/01/2016] id: Allergy 3 el: 1022 cu: CCU cg: -1
t0: [09:00:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [09:00:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:00:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [09:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 105 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [09:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [09:00:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 66 u1: kg st: NotStopd t0: [09:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 39 u1: BPM st: NotStopd t0: [09:00:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 12/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CSRU cg: RN ai: -1 vo: 45 vu: ml t0: [09:00:00 12/01/2016] id: BUMEX 12mg/500ml Free Form Intake el: 1 cu: CSRU cg: RN vo: 10.4 vu: ml t0: [09:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 2 cu: CSRU cg: RN ai: 107 vo: 4 vu: ml t0: [09:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CSRU cg: RN ai: 106 vo: 4 vu: ml
t0: [09:00:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 12/01/2016] dt: 1 id: Total Hourly Output el: 3 cu: -1 cg: RN cv: 0 ap: none t0: [23:00:00 12/01/2016] dt: 1 id: Net Hourly Balance el: 3 cu: -1 cg: RN cv: 0 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: IV Infusion In Total el: 3 cu: -1 cg: RN cv: 173.75 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: IV Nutrition Total el: 3 cu: -1 cg: RN cv: 450 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: 24h Total In el: 3 cu: -1 cg: RN cv: 887.75 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: Urine Out Total el: 3 cu: -1 cg: RN cv: 1030 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: 24h Net Body Balance el: 3 cu: -1 cg: RN cv: -297.25 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: 24h Total Out el: 3 cu: -1 cg: RN cv: 1185 ap: none t0: [23:00:00 12/01/2016] dt: multiple days id: LOS Net Body Balance el: 3 cu: -1 cg: RN cv: 8494.12 ap: carryForward
t0: [08:46:00 12/01/2016] id: high min. vol el: 0 cu: CSRU cg: RRT v1: 15 t0: [08:46:00 12/01/2016] id: ETT Mark/Location el: 0 cu: CSRU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [08:46:00 12/01/2016] id: FiO2 Set el: 0 cu: CSRU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:46:00 12/01/2016] id: High Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [08:46:00 12/01/2016] id: High Resp. Rate el: 0 cu: CSRU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [08:46:00 12/01/2016] id: Airway Size el: 0 cu: CSRU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:46:00 12/01/2016] id: Airway Type el: 0 cu: CSRU cg: RRT v1: Endotracheal st: NotStopd t0: [08:46:00 12/01/2016] id: Inspired Gas Temp el: 0 cu: CSRU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [08:46:00 12/01/2016] id: Intubation Date el: 0 cu: CSRU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:46:00 12/01/2016] id: Low Exhaled Min Vol el: 0 cu: CSRU cg: RRT v1: 8.5 st: NotStopd t0: [08:46:00 12/01/2016] id: Mean Airway Pressure el: 0 cu: CSRU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [08:46:00 12/01/2016] id: Minute Volume(Obser) el: 0 cu: CSRU cg: RRT v1: 13 u1: L/min st: NotStopd t0: [08:46:00 12/01/2016] id: PEEP Set el: 0 cu: CSRU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [08:46:00 12/01/2016] id: Apnea Time Interval el: 0 cu: CSRU cg: RRT v1: 20 st: NotStopd t0: [08:46:00 12/01/2016] id: Peak Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [08:46:00 12/01/2016] id: Plateau Pressure el: 0 cu: CSRU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [08:46:00 12/01/2016] id: Resp Rate (Spont) el: 0 cu: CSRU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [08:46:00 12/01/2016] id: Resp Rate (Total) el: 0 cu: CSRU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [08:46:00 12/01/2016] id: Respiratory Rate Set el: 0 cu: CSRU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:46:00 12/01/2016] id: Sensitivity-Vent el: 0 cu: CSRU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:46:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:46:00 12/01/2016] id: Sputum Source/Amt el: 0 cu: CSRU cg: RRT v1: Suctioned v2: None st: NotStopd t0: [08:46:00 12/01/2016] id: TCPCV Fixed I Time el: 0 cu: CSRU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [08:46:00 12/01/2016] id: TCPCV I:E Ratio el: 0 cu: CSRU cg: RRT v1: 1:3 st: NotStopd t0: [08:46:00 12/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CSRU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [08:46:00 12/01/2016] id: TCPCV Insp. Time el: 0 cu: CSRU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [08:46:00 12/01/2016] id: TCPCV-MAP el: 0 cu: CSRU cg: RRT v1: 18 st: NotStopd t0: [08:46:00 12/01/2016] id: Tidal Volume (Obser) el: 0 cu: CSRU cg: RRT v1: 347 u1: ml/B st: NotStopd t0: [08:46:00 12/01/2016] id: Ventilator Mode el: 0 cu: CSRU cg: RRT v1: Pressure Control st: NotStopd t0: [08:46:00 12/01/2016] id: Ventilator Type el: 0 cu: CSRU cg: RRT v1: Drager st: NotStopd t0: [08:46:00 12/01/2016] id: Waveform-Vent el: 0 cu: CSRU cg: RRT v1: RAMP st: NotStopd
t0: [09:30:00 12/01/2016] id: Service Type el: 0 cu: CSRU cg: RN v1: MICU st: NotStopd t0: [09:30:00 12/01/2016] id: Code Status el: 0 cu: CSRU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 12/01/2016] id: Risk for Falls el: 0 cu: CSRU cg: RN v1: Yes st: NotStopd t0: [09:30:00 12/01/2016] id: Ectopy Type el: 0 cu: CSRU cg: RN v1: None st: NotStopd t0: [09:30:00 12/01/2016] id: Heart Rate el: 0 cu: CSRU cg: RN v1: 74 u1: BPM st: NotStopd t0: [09:30:00 12/01/2016] id: Heart Rhythm el: 0 cu: CSRU cg: RN v1: Normal Sinus st: NotStopd t0: [09:30:00 12/01/2016] id: Arterial BP el: 0 cu: CSRU cg: RN v1: 103 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [09:30:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CSRU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [09:30:00 12/01/2016] id: Precautions el: 0 cu: CSRU cg: RN v1: Universal st: NotStopd t0: [09:30:00 12/01/2016] id: Previous WeightF el: 0 cu: CSRU cg: RN v1: 66 u1: kg st: NotStopd t0: [09:30:00 12/01/2016] id: Respiratory Rate el: 0 cu: CSRU cg: RN v1: 14 u1: BPM st: NotStopd t0: [09:30:00 12/01/2016] id: Significant Events el: 0 cu: CSRU cg: RN st: NotStopd t0: [09:30:00 12/01/2016] id: SpO2 el: 0 cu: CSRU cg: RN v1: 100 u1: % st: NotStopd t0: [09:30:00 12/01/2016] id: calprevflg el: 0 cu: CSRU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:30:00 12/01/2016] id: Fentanyl el: 2 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:30:00 12/01/2016] id: Midazolam el: 1 cu: CSRU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
tf: [18:30:00 19/01/2016] dt: 10596 cu: CCU de: MICU
t0: [10:00:00 12/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [10:00:00 12/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [10:00:00 12/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [10:00:00 12/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [10:00:00 12/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [10:00:00 12/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [10:00:00 12/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [10:00:00 12/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [10:00:00 12/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [10:00:00 12/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8.5 st: NotStopd t0: [10:00:00 12/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [10:00:00 12/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [10:00:00 12/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [10:00:00 12/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 12.6 u1: L/min st: NotStopd t0: [10:00:00 12/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [10:00:00 12/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [10:00:00 12/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [10:00:00 12/01/2016] id: Plateau Pressure el: 0 cu: CCU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [10:00:00 12/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [10:00:00 12/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [10:00:00 12/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [10:00:00 12/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [10:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 96 u1: % st: NotStopd t0: [10:00:00 12/01/2016] id: Sputum Color/Consist el: 0 cu: CCU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [10:00:00 12/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [10:00:00 12/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [10:00:00 12/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [10:00:00 12/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [10:00:00 12/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [10:00:00 12/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 19 st: NotStopd t0: [10:00:00 12/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 349 u1: ml/B st: NotStopd t0: [10:00:00 12/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [10:00:00 12/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [10:00:00 12/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: SQUARE st: NotStopd
t0: [10:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [10:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 12/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [10:00:00 12/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: No/Not Sedated st: NotStopd t0: [10:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 73 u1: BPM st: NotStopd t0: [10:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 97 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [10:00:00 12/01/2016] id: Pain Management el: 1 cu: CCU cg: RN v1: IV Gtt st: NotStopd t0: [10:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [10:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [10:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 12/01/2016] tf: [18:30:00 19/01/2016] dt: 10590 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 12/01/2016] tf: [18:30:00 19/01/2016] dt: 10590 id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [10:00:00 12/01/2016] tf: [18:30:00 19/01/2016] dt: 10590 id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [10:00:00 12/01/2016] tf: [18:30:00 19/01/2016] dt: 10590 id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 12/01/2016] tf: [18:30:00 19/01/2016] dt: 10590 id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:30:00 12/01/2016] id: Temp. Site el: 0 cu: CCU cg: CoWker v1: Rectal st: NotStopd t0: [10:30:00 12/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: CoWker v1: 37.6667 u1: Deg. C st: NotStopd t0: [10:30:00 12/01/2016] id: Temperature F el: 0 cu: CCU cg: CoWker v1: 99.8 u1: Deg. F st: NotStopd
t0: [10:00:00 12/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [10:00:00 12/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Positive st: NotStopd t0: [10:00:00 12/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [10:00:00 12/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 12/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [10:00:00 12/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [10:00:00 12/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 12/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [10:00:00 12/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [10:00:00 12/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [10:00:00 12/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [10:00:00 12/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [10:00:00 12/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Low Cont Suction v2: Bilious st: NotStopd t0: [10:00:00 12/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [10:00:00 12/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [10:00:00 12/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm Distended st: NotStopd t0: [10:00:00 12/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [10:00:00 12/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [10:00:00 12/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [10:00:00 12/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [10:00:00 12/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 12/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 12/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [10:00:00 12/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 12/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [10:00:00 12/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [10:00:00 12/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 12/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 12/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [10:00:00 12/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 12/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 12/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 12/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 12/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 12/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [10:00:00 12/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 12/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [10:00:00 12/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [10:00:00 12/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [10:00:00 12/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Positive st: NotStopd t0: [10:00:00 12/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [10:00:00 12/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [10:30:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [10:30:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [10:30:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:30:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:30:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:30:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:30:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 74 u1: BPM st: NotStopd t0: [10:30:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [10:30:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 92 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [10:30:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [10:30:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:30:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [10:30:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [10:30:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [10:30:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 12/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [11:00:00 12/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [11:00:00 12/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [11:00:00 12/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 12/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 12/01/2016] id: ImpSkin Character #1 el: 0 cu: CCU cg: RN v1: Abrasion st: NotStopd t0: [11:00:00 12/01/2016] id: ImpSkin Character #2 el: 0 cu: CCU cg: RN v1: Blister st: NotStopd t0: [11:00:00 12/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 12/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CCU cg: RN v1: Serous st: NotStopd t0: [11:00:00 12/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Open to Air st: NotStopd t0: [11:00:00 12/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [11:00:00 12/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CCU cg: RN v1: Purple st: NotStopd t0: [11:00:00 12/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [11:00:00 12/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [11:00:00 12/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [11:00:00 12/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CCU cg: RN v1: Approximated st: NotStopd t0: [11:00:00 12/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None v2: Scant st: NotStopd t0: [11:00:00 12/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 12/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [11:00:00 12/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [11:00:00 12/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 12/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 12/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [11:00:00 12/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [11:00:00 12/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [11:00:00 12/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [11:00:00 12/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 12/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 12/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 12/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [11:00:00 12/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [11:00:00 12/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [11:00:00 12/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [11:00:00 12/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [11:00:00 12/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [11:00:00 12/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd
t0: [11:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [11:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [10:30:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:30:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:00:00 12/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [10:00:00 12/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [10:00:00 12/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [10:00:00 12/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 9 u1: points st: NotStopd t0: [10:00:00 12/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [10:00:00 12/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [10:00:00 12/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 12/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [10:00:00 12/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [10:00:00 12/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [11:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [11:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [11:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [11:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [11:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 93 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [11:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [11:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [11:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [11:00:00 12/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [11:00:00 12/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [11:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [12:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [12:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [12:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [12:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 94 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [12:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [12:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [12:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [12:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [12:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [12:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 12/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 109 rs: Manual st: NotStopd
t0: [13:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [13:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [13:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [13:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [13:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 94 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [13:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [13:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [13:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [13:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
tf: [12:00:00 13/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 13 dn: 1 m1: Potassium Chloride v1: 20 u1: mEq m2: SW v2: 50 u2: ml tf: [12:00:00 13/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 13 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [10:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 37 u1: BPM st: NotStopd t0: [11:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN u1: BPM st: NotStopd t0: [12:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN u1: BPM st: NotStopd t0: [13:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN u1: BPM st: NotStopd t0: [14:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [14:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [14:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [14:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 92 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [14:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [14:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [14:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 36 u1: BPM st: NotStopd t0: [14:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [14:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd
t0: [14:00:00 12/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [14:00:00 12/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 12/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 12/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 12/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 12/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [14:00:00 12/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [14:00:00 12/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [14:00:00 12/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [14:00:00 12/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 8 u1: points st: NotStopd t0: [14:00:00 12/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [14:00:00 12/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [14:00:00 12/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [14:00:00 12/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 12/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 12/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 12/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [14:00:00 12/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [14:00:00 12/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [14:00:00 12/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 12/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [14:00:00 12/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [14:00:00 12/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 12/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 12/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 12/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 12/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [14:00:00 12/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 12/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 12/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [14:00:00 12/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 12/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 12/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 12/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 12/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [14:00:00 12/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 12/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 12/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 12/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [15:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [15:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 15 u1: mmHg st: NotStopd t0: [15:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [15:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [15:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 92 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [15:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [15:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [15:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [15:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 27 u1: BPM st: NotStopd t0: [15:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 15 vu: ml t0: [15:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 12 vu: ml t0: [15:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 9 vu: ml
t0: [15:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 12/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Axillary st: NotStopd t0: [15:00:00 12/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.2778 u1: Deg. C st: NotStopd t0: [15:00:00 12/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.3 u1: Deg. F st: NotStopd
t0: [04:56:00 12/01/2016] tf: [09:53:00 12/01/2016] dt: 297 id: Triglyceride Chemistry el: 0 cu: CCU cg: 140 v1: 67 rs: Final st: NotStopd t0: [04:56:00 12/01/2016] tf: [09:53:00 12/01/2016] dt: 297 id: Triglyceride (0-200) Chemistry el: 0 cu: CCU cg: 140 v1: 67 rs: Final st: NotStopd
t0: [15:00:00 12/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [15:00:00 12/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [15:00:00 12/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 55 u1: cmH2O st: NotStopd t0: [15:00:00 12/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [15:00:00 12/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [15:00:00 12/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [15:00:00 12/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [15:00:00 12/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [15:00:00 12/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [15:00:00 12/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8.5 st: NotStopd t0: [15:00:00 12/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [15:00:00 12/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [15:00:00 12/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [15:00:00 12/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [15:00:00 12/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [15:00:00 12/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [15:00:00 12/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 39 u1: cmH2O st: NotStopd t0: [15:00:00 12/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [15:00:00 12/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [15:00:00 12/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [15:00:00 12/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [15:00:00 12/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [15:00:00 12/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [15:00:00 12/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [15:00:00 12/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [15:00:00 12/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 21 st: NotStopd t0: [15:00:00 12/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 295 u1: ml/B st: NotStopd t0: [15:00:00 12/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [15:00:00 12/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [15:00:00 12/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: SQUARE st: NotStopd
t0: [16:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [16:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [16:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [16:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 90 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [16:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [16:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [16:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [16:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 26 u1: BPM st: NotStopd t0: [16:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [16:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [16:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 12/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 112 rs: Manual st: NotStopd
t0: [16:31:00 12/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.38 rs: Final st: NotStopd t0: [16:31:00 12/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [16:31:00 12/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 29 rs: Final st: NotStopd t0: [16:31:00 12/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 48 u1: mmHg rs: Final st: NotStopd t0: [16:31:00 12/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 184 u1: mmHg rs: Final st: NotStopd t0: [16:31:00 12/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.38 rs: Final st: NotStopd
t0: [17:00:00 12/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [17:00:00 12/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 12/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 12/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 12/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 12/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [17:00:00 12/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.9 u1: L/min st: NotStopd t0: [17:00:00 12/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 12/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [17:00:00 12/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [17:00:00 12/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [17:00:00 12/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [17:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 100 u1: % st: NotStopd t0: [17:00:00 12/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 290 u1: ml/B st: NotStopd t0: [17:00:00 12/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd
io: Promote Tube Feeding el: 1 cu: CCU cg: RN ra: 10 ru: ml/hr
id: Promote el: 1 cu: CCU cg: RN io: Promote Tube Feeding du: str rt: Gastric/Feeding Tube id: TF Residual el: 1 cu: CCU cg: RN io: TF Residual Gastric/TF Residual du: ml rt: Gastric/Feeding Tube
t0: [17:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [17:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [17:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [17:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [17:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 90 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [17:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [17:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [17:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 34 u1: BPM st: NotStopd t0: [17:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 12/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vu: ml nb: 1 t0: [17:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [17:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [17:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [18:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [18:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [18:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [18:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 99 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [18:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [18:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [18:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [18:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [18:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 12/01/2016] dt: 24 id: Chest Tube Out Total el: 1 cu: CCU cg: RN cv: 225 ap: none
t0: [18:34:00 12/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.34 rs: Final st: NotStopd t0: [18:34:00 12/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [18:34:00 12/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 31 rs: Final st: NotStopd t0: [18:34:00 12/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 55 u1: mmHg rs: Final st: NotStopd t0: [18:34:00 12/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 141 u1: mmHg rs: Final st: NotStopd t0: [18:34:00 12/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.34 rs: Final st: NotStopd
tf: [18:00:00 13/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 19 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [19:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [19:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [19:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [19:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [19:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 94 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [19:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [19:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [19:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [19:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 12/01/2016] tf: [23:00:00 12/01/2016] dt: 360 id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml t0: [18:00:00 12/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml t0: [19:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [19:00:00 12/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml t0: [19:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [19:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [17:00:00 12/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 20 u1: cmH2O st: NotStopd
t0: [20:00:00 12/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: 1341 v1: 25cm v2: Lip st: NotStopd t0: [20:00:00 12/01/2016] id: FiO2 Set el: 0 cu: CCU cg: 1341 v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 12/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: 1341 v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 12/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: 1341 v1: 10 u1: BPM st: NotStopd t0: [20:00:00 12/01/2016] id: I:E Ratio el: 0 cu: CCU cg: 1341 v1: 1:3.0 st: NotStopd t0: [20:00:00 12/01/2016] id: Airway Size el: 0 cu: CCU cg: 1341 v1: 7.5 mm st: NotStopd t0: [20:00:00 12/01/2016] id: Airway Type el: 0 cu: CCU cg: 1341 v1: Endotracheal st: NotStopd t0: [20:00:00 12/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: 1341 v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 12/01/2016] id: Intubation Date el: 0 cu: CCU cg: 1341 v1: 12 v2: 23 st: NotStopd t0: [20:00:00 12/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: 1341 v1: 8 st: NotStopd t0: [20:00:00 12/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: 1341 v1: 11 u1: cmH2O st: NotStopd t0: [20:00:00 12/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: 1341 v1: 9.8 u1: L/min st: NotStopd t0: [20:00:00 12/01/2016] id: PEEP Set el: 0 cu: CCU cg: 1341 v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 12/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: 1341 v1: 20 st: NotStopd t0: [20:00:00 12/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: 1341 v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 12/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: 1341 v1: 5 u1: BPM st: NotStopd t0: [20:00:00 12/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: 1341 v1: 35 u1: BPM st: NotStopd t0: [20:00:00 12/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: 1341 v1: 30 u1: BPM st: NotStopd t0: [20:00:00 12/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: 1341 v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: 1341 v1: 97 u1: % st: NotStopd t0: [20:00:00 12/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: 1341 v1: Insp. Time Fixed st: NotStopd t0: [20:00:00 12/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: 1341 v1: 1:3 st: NotStopd t0: [20:00:00 12/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: 1341 v1: 28 u1: cmH2O st: NotStopd t0: [20:00:00 12/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: 1341 v1: 0.5 u1: sec st: NotStopd t0: [20:00:00 12/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: 1341 v1: 11 st: NotStopd t0: [20:00:00 12/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: 1341 v1: 280 u1: ml/B st: NotStopd t0: [20:00:00 12/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: 1341 v1: Pressure Control st: NotStopd t0: [20:00:00 12/01/2016] id: Ventilator Type el: 0 cu: CCU cg: 1341 v1: Drager st: NotStopd
t0: [20:00:00 12/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: 1341 v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 12/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: 1341 v1: 6 v2: Atrovent st: NotStopd
t0: [21:14:00 12/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.37 rs: Final st: NotStopd t0: [21:14:00 12/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [21:14:00 12/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 29 rs: Final st: NotStopd t0: [21:14:00 12/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 49 u1: mmHg rs: Final st: NotStopd t0: [21:14:00 12/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 125 u1: mmHg rs: Final st: NotStopd t0: [21:14:00 12/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.37 rs: Final st: NotStopd
t0: [20:00:00 12/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [20:00:00 12/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Change in Vitals st: NotStopd t0: [20:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [20:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [20:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 12/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 12/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [20:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 12/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [20:00:00 12/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [20:00:00 12/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 8 u1: points st: NotStopd t0: [20:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [20:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 12/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [20:00:00 12/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 12/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 12/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 94 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [20:00:00 12/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [20:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [20:00:00 12/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 12/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: Pinpoint v2: Pinpoint st: NotStopd t0: [20:00:00 12/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [20:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 37 u1: BPM st: NotStopd t0: [20:00:00 12/01/2016] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 12/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 12/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [20:00:00 12/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [20:00:00 12/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [20:00:00 12/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [21:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [21:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [21:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 89 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [21:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [21:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [21:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [21:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 34 u1: BPM st: NotStopd t0: [21:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [21:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [20:00:00 12/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml t0: [20:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml t0: [21:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [21:00:00 12/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml t0: [21:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [20:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
id: Neosynephrine-k el: 100 cu: CCU cg: RN io: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions am: 60 du: mcgkgmin rt: IV Drip
io: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ra: 4.95 ru: ml/hr
tf: [11:00:00 13/01/2016] pt: Unit Dose rt: IV fr: BID fs: 10, 22 dn: 2 m1: Bumetanide v1: 2 u1: mg
id: D5W el: 1 cu: CCU cg: RN io: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [21:15:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [21:15:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [21:15:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [21:15:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:15:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:15:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:15:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [21:15:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [21:15:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 83 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [21:15:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [21:15:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [21:15:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [21:15:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [21:15:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [21:15:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:30:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [21:30:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [21:30:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [21:30:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:30:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:30:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:30:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [21:30:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [21:30:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 83 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [21:30:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [21:30:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [21:30:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [21:30:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 10 u1: BPM st: NotStopd t0: [21:30:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [21:30:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:45:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [21:45:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [21:45:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [21:45:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:45:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:45:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:45:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [21:45:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [21:45:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 99 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [21:45:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [21:45:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [21:45:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [21:45:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [21:45:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [21:45:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [22:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [22:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 67 u1: BPM st: NotStopd t0: [22:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 126 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [22:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [22:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [22:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [22:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:30:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [22:30:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [22:30:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:30:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:30:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:30:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:30:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [22:30:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [22:30:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 85 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [22:30:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [22:30:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:30:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [22:30:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [22:30:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [22:30:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:15:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:15:00 12/01/2016] tf: [22:00:00 12/01/2016] dt: 45 id: Neosynephrine-k el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:30:00 12/01/2016] tf: [01:15:00 13/01/2016] dt: 165 id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:30:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:30:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:30:00 12/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:45:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:45:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:45:00 12/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.5 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 12/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped t0: [22:30:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:30:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:30:00 12/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [21:15:00 12/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 0 vu: ml nb: 1 t0: [22:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [22:00:00 12/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml t0: [22:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
tf: [22:00:00 13/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 23 dn: 1 m1: Bumetanide v1: 2 u1: mg tf: [14:00:00 15/01/2016] pt: Unit Dose rt: IV fr: QID:PRN m1: Metoclopramide v1: 10 u1: mg tf: [15:00:00 03/02/2016] pt: Unit Dose rt: PO fr: QID:PRN m1: Metoclopramide v1: 10 u1: mg
t0: [23:00:00 12/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [23:00:00 12/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [23:00:00 12/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 12/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [23:00:00 12/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 66 u1: BPM st: NotStopd t0: [23:00:00 12/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 95 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [23:00:00 12/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [23:00:00 12/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [23:00:00 12/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [23:00:00 12/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [23:00:00 12/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 12/01/2016] tf: [20:00:00 15/01/2016] dt: 4140 id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 100 vu: ml t0: [23:00:00 12/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 12/01/2016] tf: [03:00:00 13/01/2016] dt: 240 id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 10.3125 vu: ml t0: [23:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [23:00:00 12/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml st: Stopped t0: [23:00:00 12/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [23:00:00 12/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 12/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 12/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [23:00:00 12/01/2016] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN pv: 10 cv: 10 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN pv: 24.3125 cv: 361.062 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: Tube Feeds In Total el: 1 cu: CCU cg: RN pv: 10 cv: 70 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN pv: 10 cv: 1700 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN pv: 10 cv: 1925 ap: none
t0: [01:00:00 13/01/2016] id: Chest PT R/L el: 0 cu: CCU cg: -1 st: D/C'd t0: [01:00:00 13/01/2016] id: Cough/Deep Breathe el: 0 cu: CCU cg: -1 st: D/C'd t0: [01:00:00 13/01/2016] id: Incentive Spirometry el: 0 cu: CCU cg: -1 st: D/C'd
t0: [20:00:00 12/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 12/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [20:00:00 12/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 12/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 12/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 12/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 12/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 12/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [20:00:00 12/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 12/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 12/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [20:00:00 12/01/2016] id: Family Communication el: 0 cu: CCU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 12/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 12/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [20:00:00 12/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 12/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 12/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 12/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 12/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 12/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [20:00:00 12/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 12/01/2016] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 12/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 12/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 12/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 12/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [20:00:00 12/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 12/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [20:00:00 12/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 12/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CCU cg: RN v1: Open v2: Necrotic st: NotStopd t0: [20:00:00 12/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 12/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: Brown st: NotStopd t0: [20:00:00 12/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 12/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg v2: Changed st: NotStopd t0: [20:00:00 12/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 12/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 12/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 12/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 12/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 12/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 12/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [20:00:00 12/01/2016] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [20:00:00 12/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 1 Person Assist st: NotStopd t0: [20:00:00 12/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 12/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 12/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 12/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 12/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 12/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 12/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: BehaviorSubsided st: NotStopd t0: [20:00:00 12/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 12/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 12/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Clammy st: NotStopd t0: [20:00:00 12/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 12/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd t0: [20:00:00 12/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 12/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 12/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [20:00:00 12/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 12/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 12/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Comp. Immobile st: NotStopd t0: [20:00:00 12/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Moist st: NotStopd t0: [20:00:00 12/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 12/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 9 u1: number st: NotStopd t0: [20:00:00 12/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Comp. Limited st: NotStopd t0: [20:00:00 12/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [20:00:00 12/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 12/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 12/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [20:00:00 12/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 12/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [20:00:00 12/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [21:00:00 12/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [22:00:00 12/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 12/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 12/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 12/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: BehaviorSubsided st: NotStopd t0: [22:00:00 12/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [23:00:00 12/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 12/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 12/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 12/01/2016] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [23:00:00 12/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [00:00:00 13/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 13/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [00:00:00 13/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 13/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [00:00:00 13/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 13/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Change in Vitals st: NotStopd t0: [00:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [00:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [00:00:00 13/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 13/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 13/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 13/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 13/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [00:00:00 13/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 13/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [00:00:00 13/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 13/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 13/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [00:00:00 13/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [00:00:00 13/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [00:00:00 13/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 7 u1: points st: NotStopd t0: [00:00:00 13/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 13/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 13/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 13/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 13/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [00:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 66 u1: BPM st: NotStopd t0: [00:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 13/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: Reverse T-Berg st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 13/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 13/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [00:00:00 13/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 13/01/2016] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 13/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 13/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 13/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 13/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [00:00:00 13/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 13/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [00:00:00 13/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 13/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 13/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 13/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 13/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [00:00:00 13/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 13/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 13/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 13/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 13/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 13/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [00:00:00 13/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 13/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 13/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 100 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [00:00:00 13/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [00:00:00 13/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 13/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/01/2016] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 13/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:00:00 13/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [00:00:00 13/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 13/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: Pinpoint v2: Pinpoint st: NotStopd t0: [00:00:00 13/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 13/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 13/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 13/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [00:00:00 13/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 13/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 13/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 13/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 13/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 13/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Clammy st: NotStopd t0: [00:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [00:00:00 13/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 13/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [00:00:00 13/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.8333 u1: Deg. C st: NotStopd t0: [00:00:00 13/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 96.5 u1: Deg. F st: NotStopd t0: [00:00:00 13/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 13/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 13/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 13/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 13/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [00:00:00 13/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [00:00:00 13/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [00:00:00 13/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 13/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [00:00:00 13/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 13/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [00:00:00 13/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [01:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [01:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [01:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: Rare st: NotStopd t0: [01:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: PAC's st: NotStopd t0: [01:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [01:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 97 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [01:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [01:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [01:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [01:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:15:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [01:15:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [01:15:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:15:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:15:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 63 u1: BPM st: NotStopd t0: [01:15:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 106 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [01:15:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [01:15:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:15:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [01:15:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [01:15:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [01:15:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 4.95 vu: ml t0: [00:00:00 13/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [01:00:00 13/01/2016] tf: [04:00:00 13/01/2016] dt: 180 id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 0 vu: ml nb: 1 t0: [00:00:00 13/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml t0: [01:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 4.95 vu: ml t0: [01:00:00 13/01/2016] id: .9% Normal Saline 50.0ml + 2500mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [01:00:00 13/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml t0: [01:00:00 13/01/2016] id: .9% Normal Saline 50.0ml + 50mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [00:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:15:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:15:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:15:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped
t0: [23:00:00 12/01/2016] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: RN cv: 110 ap: none t0: [23:00:00 12/01/2016] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: 140 cv: 8804.77 ap: carryForward t0: [23:00:00 13/01/2016] dt: 24 id: IV Nutrition Total el: 1 cu: CCU cg: RN pv: 45 cv: 135 ap: none t0: [23:00:00 13/01/2016] dt: 24 id: Chest Tube Out Total el: 1 cu: CCU cg: RN cv: 55 ap: none
t0: [01:18:00 13/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.3 rs: Final st: NotStopd t0: [01:18:00 13/01/2016] id: CaO2 el: 0 cu: CCU cg: 140 v1: 13.961 u1: ml/dl st: NotStopd t0: [01:18:00 13/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 82 rs: Final st: NotStopd t0: [01:18:00 13/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 0 rs: Final st: NotStopd t0: [01:18:00 13/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 30 rs: Final st: NotStopd t0: [01:18:00 13/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 59 u1: mmHg rs: Final st: NotStopd t0: [01:18:00 13/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 101 u1: mmHg rs: Final st: NotStopd t0: [01:18:00 13/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.3 rs: Final st: NotStopd t0: [01:18:00 13/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 82 rs: Final st: NotStopd t0: [01:18:00 13/01/2016] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 97 u1: % rs: Final st: NotStopd
t0: [23:00:00 12/01/2016] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: 140 pv: 24.3125 cv: 24.3125 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: IV Nutrition Total el: 1 cu: CCU cg: 140 cv: 900 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: 24h Total In el: 1 cu: CCU cg: 140 pv: 34.3125 cv: 1728.26 ap: none t0: [23:00:00 12/01/2016] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: 140 pv: 24.3125 cv: -196.738 ap: none
t0: [22:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 34 u1: BPM st: NotStopd t0: [23:00:00 12/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd t0: [00:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [01:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd
t0: [02:00:00 13/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.29 rs: Final st: NotStopd t0: [02:00:00 13/01/2016] id: CaO2 el: 0 cu: CCU cg: 140 v1: 13.9765 u1: ml/dl st: NotStopd t0: [02:00:00 13/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 0 rs: Final st: NotStopd t0: [02:00:00 13/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 29 rs: Final st: NotStopd t0: [02:00:00 13/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 57 u1: mmHg rs: Final st: NotStopd t0: [02:00:00 13/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 106 u1: mmHg rs: Final st: NotStopd t0: [02:00:00 13/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.29 rs: Final st: NotStopd t0: [02:00:00 13/01/2016] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 97 u1: % rs: Final st: NotStopd
t0: [02:17:00 13/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [02:17:00 13/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [02:17:00 13/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [02:17:00 13/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [02:17:00 13/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [02:17:00 13/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [02:17:00 13/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [02:17:00 13/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 34.8 u1: Deg. C st: NotStopd t0: [02:17:00 13/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [02:17:00 13/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [02:17:00 13/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [02:17:00 13/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [02:17:00 13/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [02:17:00 13/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [02:17:00 13/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [02:17:00 13/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [02:17:00 13/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [02:17:00 13/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [02:17:00 13/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [02:17:00 13/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [02:17:00 13/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [02:17:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 97 u1: % st: NotStopd t0: [02:17:00 13/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [02:17:00 13/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [02:17:00 13/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [02:17:00 13/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [02:17:00 13/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 12 st: NotStopd t0: [02:17:00 13/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 245 u1: ml/B st: NotStopd t0: [02:17:00 13/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [02:17:00 13/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd
t0: [02:30:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [02:30:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [02:30:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [02:30:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [02:30:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:30:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:30:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 60 u1: BPM st: NotStopd t0: [02:30:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [02:30:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 107 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [02:30:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [02:30:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [02:30:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [02:30:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 42 u1: BPM st: NotStopd t0: [02:30:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [02:30:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:30:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:30:00 13/01/2016] tf: [03:00:00 13/01/2016] dt: 30 id: Neosynephrine-k el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [02:30:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [02:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 4.95 vu: ml t0: [02:00:00 13/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml t0: [02:00:00 13/01/2016] tf: [18:30:00 19/01/2016] dt: 9630 id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [02:00:00 13/01/2016] tf: [18:30:00 19/01/2016] dt: 9630 id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml t0: [03:00:00 13/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml t0: [03:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [03:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [23:00:00 13/01/2016] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN pv: 60 cv: 60 ap: none t0: [23:00:00 13/01/2016] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN pv: 17 cv: 17 ap: none t0: [23:00:00 13/01/2016] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN pv: 32 cv: 1292.81 ap: none t0: [23:00:00 13/01/2016] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN pv: 77 cv: 1527.81 ap: none t0: [23:00:00 13/01/2016] dt: 24 id: Tube Feeds In Total el: 1 cu: CCU cg: RN cv: 40 ap: none t0: [23:00:00 13/01/2016] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN pv: 60 cv: 699 ap: none t0: [23:00:00 13/01/2016] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN pv: 17 cv: 773.812 ap: none t0: [23:00:00 13/01/2016] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN pv: 60 cv: 754 ap: none t0: [23:00:00 13/01/2016] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN pv: 17 cv: 9368.45 ap: carryForward
io: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ra: 10 ru: ml/hr
t0: [03:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: -1 ai: 199 vo: 0 st: D/C'd
id: .9% Normal Saline el: 2 cu: CCU cg: RN io: .9% Normal Saline 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push
t0: [03:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [03:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [03:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [03:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 57 u1: BPM st: NotStopd t0: [03:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 117 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [03:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [03:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [03:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [03:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped
t0: [03:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd
t0: [03:16:00 13/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.31 rs: Final st: NotStopd t0: [03:16:00 13/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 0 rs: Final st: NotStopd t0: [03:16:00 13/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 30 rs: Final st: NotStopd t0: [03:16:00 13/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 57 u1: mmHg rs: Final st: NotStopd t0: [03:16:00 13/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 106 u1: mmHg rs: Final st: NotStopd t0: [03:16:00 13/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.31 rs: Final st: NotStopd t0: [03:16:00 13/01/2016] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 97 u1: % rs: Final st: NotStopd
t0: [03:00:00 13/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 10.4 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 10.4 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 33.3 u1: % rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 10.3 u1: gm/dl rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 242 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 3.52 u1: /mic l rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 10.4 rs: Final st: NotStopd t0: [03:16:00 13/01/2016] id: CaO2 el: 0 cu: CCU cg: 140 v1: 13.7165 u1: ml/dl st: NotStopd
t0: [03:00:00 13/01/2016] id: PT el: 0 cu: CCU cg: 140 v1: 15.6 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: INR Coags el: 0 cu: CCU cg: 140 v1: 1.6 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: PTT Coags el: 0 cu: CCU cg: 140 v1: 39.3 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CCU cg: 140 v1: 1.6 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: PT(11-13.5) Coags el: 0 cu: CCU cg: 140 v1: 15.6 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: PTT(22-35) Coags el: 0 cu: CCU cg: 140 v1: 39.3 rs: Final st: NotStopd
t0: [04:01:00 13/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: -1 ai: 555 vo: 0 st: D/C'd
t0: [00:00:00 13/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [00:00:00 13/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [02:00:00 13/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [02:00:00 13/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 13/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [02:00:00 13/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 13/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [02:00:00 13/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [02:00:00 13/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 13/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 13/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [03:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [04:00:00 13/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 13/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [04:00:00 13/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 13/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [04:00:00 13/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 13/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Grimace Scale st: NotStopd t0: [04:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [04:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [04:00:00 13/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 13/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 13/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 13/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 13/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 13/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [04:00:00 13/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 13/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 13/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [04:00:00 13/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 13/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Consistently st: NotStopd t0: [04:00:00 13/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 13/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 13/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [04:00:00 13/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 13/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 13/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 13/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 56 u1: BPM st: NotStopd t0: [04:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [04:00:00 13/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 13/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 13/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [04:00:00 13/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 13/01/2016] id: INV#2 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 13/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 13/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 13/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 13/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [04:00:00 13/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 13/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [04:00:00 13/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 13/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 13/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 13/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 13/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [04:00:00 13/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 13/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 13/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 13/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 13/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 13/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 13/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 13/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 13/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 122 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [04:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [04:00:00 13/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [04:00:00 13/01/2016] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 13/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:00:00 13/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [04:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:00:00 13/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 13/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: Pinpoint v2: Pinpoint st: NotStopd t0: [04:00:00 13/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 13/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 13/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 13/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [04:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 35 u1: BPM st: NotStopd t0: [04:00:00 13/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 13/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 13/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: BehaviorSubsided st: NotStopd t0: [04:00:00 13/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 13/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 13/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Clammy st: NotStopd t0: [04:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [04:00:00 13/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 13/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [04:00:00 13/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 34.7222 u1: Deg. C st: NotStopd t0: [04:00:00 13/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 94.5 u1: Deg. F st: NotStopd t0: [04:00:00 13/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd t0: [04:00:00 13/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 13/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 13/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 13/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Absent st: NotStopd t0: [04:00:00 13/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [04:00:00 13/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [04:00:00 13/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 13/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [04:00:00 13/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 13/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [04:00:00 13/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd
t0: [04:00:00 13/01/2016] tf: [11:00:00 14/01/2016] dt: 1860 id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 0 vu: ml nb: 1 t0: [04:00:00 13/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 110 vu: ml t0: [04:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 13/01/2016] id: Promote Tube Feeding el: 1 cu: CCU cg: RN ai: 555 vo: 10 vu: ml st: Stopped t0: [04:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [04:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [04:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:00:00 13/01/2016] id: BUN el: 0 cu: CCU cg: 140 v1: 52 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 108 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 2.3 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 82 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 2.4 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 5.5 u1: mEq/L rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 3.5 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 145 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 52 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 28 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 108 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 2.3 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 82 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 2.4 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 5.5 u1: mEq/L rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 3.5 rs: Final st: NotStopd t0: [03:00:00 13/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 145 rs: Final st: NotStopd
t0: [04:05:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [04:05:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [04:05:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:05:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:05:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:05:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:05:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 54 u1: BPM st: NotStopd t0: [04:05:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [04:05:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 97 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [04:05:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [04:05:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:05:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:05:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [04:05:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [04:05:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:10:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [04:10:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [04:10:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:10:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:10:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:10:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:10:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 54 u1: BPM st: NotStopd t0: [04:10:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [04:10:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 83 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [04:10:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [04:10:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:10:00 13/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:10:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:10:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [04:10:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [04:10:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:15:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [04:15:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [04:15:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:15:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:15:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:15:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:15:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 54 u1: BPM st: NotStopd t0: [04:15:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [04:15:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 76 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [04:15:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 58 u1: mmHg st: NotStopd t0: [04:15:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:15:00 13/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:15:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:15:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 2 u1: BPM st: NotStopd t0: [04:15:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [04:15:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:20:00 13/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:25:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [04:25:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [04:25:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:25:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:25:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:25:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:25:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 55 u1: BPM st: NotStopd t0: [04:25:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [04:25:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 97 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [04:25:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [04:25:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:25:00 13/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:25:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:25:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [04:25:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [04:25:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:05:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:15:00 13/01/2016] tf: [04:30:00 13/01/2016] dt: 15 id: Neosynephrine-k el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:10:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:10:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:15:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:15:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:15:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [04:25:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:25:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:25:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:00:00 13/01/2016] tf: [17:00:00 13/01/2016] dt: 780 id: WarmingDevice/Status el: 0 cu: CCU cg: RN v1: Bair Hugger v2: On st: NotStopd
t0: [04:30:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [04:30:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [04:30:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:30:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:30:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:30:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:30:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 55 u1: BPM st: NotStopd t0: [04:30:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [04:30:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 154 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [04:30:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [04:30:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:30:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:30:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [04:30:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [04:30:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:30:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:30:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:30:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip st: Stopped
t0: [05:33:00 13/01/2016] id: RSBI Not Completed el: 0 cu: CCU cg: RRT v1: Other/Remarks st: NotStopd t0: [05:33:00 13/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [05:33:00 13/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [05:33:00 13/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [05:33:00 13/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [05:33:00 13/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [05:33:00 13/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:33:00 13/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [05:33:00 13/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [05:33:00 13/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:33:00 13/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [05:33:00 13/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:33:00 13/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:33:00 13/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [05:33:00 13/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 12.4 u1: L/min st: NotStopd t0: [05:33:00 13/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:33:00 13/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [05:33:00 13/01/2016] id: Peak Flow el: 0 cu: CCU cg: RRT u1: L/m st: NotStopd t0: [05:33:00 13/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [05:33:00 13/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [05:33:00 13/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [05:33:00 13/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [05:33:00 13/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [05:33:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 97 u1: % st: NotStopd t0: [05:33:00 13/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [05:33:00 13/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [05:33:00 13/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [05:33:00 13/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 12 st: NotStopd t0: [05:33:00 13/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 280 u1: ml/B st: NotStopd t0: [05:33:00 13/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [05:33:00 13/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd
t0: [05:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [05:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [05:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 55 u1: BPM st: NotStopd t0: [05:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [05:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 73 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [05:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 57 u1: mmHg st: NotStopd t0: [05:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [05:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [05:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [05:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:05:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [05:05:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 13 u1: mmHg st: NotStopd t0: [05:05:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:05:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:05:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:05:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:05:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 55 u1: BPM st: NotStopd t0: [05:05:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [05:05:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 90 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [05:05:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [05:05:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:05:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [05:05:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [05:05:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:10:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [05:10:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [05:10:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:10:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:10:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:10:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:10:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 55 u1: BPM st: NotStopd t0: [05:10:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [05:10:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 153 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [05:10:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [05:10:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:10:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [05:10:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [05:10:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [05:10:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:15:00 13/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [05:30:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [05:30:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [05:30:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:30:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:30:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:30:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:30:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 57 u1: BPM st: NotStopd t0: [05:30:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [05:30:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 120 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [05:30:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [05:30:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:30:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [05:30:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [05:30:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [05:30:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 13/01/2016] tf: [18:30:00 19/01/2016] dt: 9450 id: Neosynephrine-k el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:05:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:05:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:05:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.6 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:10:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:10:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:10:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.121212 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:30:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:30:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:30:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.12 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [05:00:00 13/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [05:00:00 13/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 34.7222 u1: Deg. C st: NotStopd t0: [05:00:00 13/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 94.5 u1: Deg. F st: NotStopd t0: [06:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [06:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [06:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [06:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 57 u1: BPM st: NotStopd t0: [06:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [06:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 98 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [06:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [06:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [06:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [06:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [06:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [06:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 13/01/2016] tf: [15:00:00 13/01/2016] dt: 600 id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 9.9 vu: ml t0: [05:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [05:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml t0: [06:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 2.89417 vu: ml t0: [06:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [06:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [06:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.12 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [06:10:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 89 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [06:10:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 67 u1: mmHg st: NotStopd
t0: [06:10:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.3 du: mcgkgmin sv: 250 su: ml rt: IV Drip
id: Fentanyl el: 102 cu: CCU cg: RN io: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions am: 5000 du: mcghr rt: IV Drip id: Midazolam el: 101 cu: CCU cg: RN io: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions am: 100 du: mghr rt: IV Drip
t0: [06:00:00 13/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [06:00:00 13/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 34.8333 u1: Deg. C st: NotStopd t0: [06:00:00 13/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 94.7 u1: Deg. F st: NotStopd
id: .9% Normal Saline el: 1 cu: CCU cg: RN io: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions vo: 100 du: ml rt: Intravenous Push id: .9% Normal Saline el: 1 cu: CCU cg: RN io: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions vo: 100 du: ml rt: Intravenous Push
t0: [00:00:00 13/01/2016] id: ETT Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd
t0: [06:15:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:15:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [05:00:00 13/01/2016] id: WarmingDevice/Status el: 0 cu: CCU cg: RN v1: Bair Hugger v2: On st: NotStopd t0: [06:00:00 13/01/2016] id: WarmingDevice/Status el: 0 cu: CCU cg: RN v1: Bair Hugger v2: On st: NotStopd
t0: [01:00:00 13/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [05:33:00 13/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [06:00:00 13/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd
t0: [06:45:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [06:45:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [06:45:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [06:45:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [06:45:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:45:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:45:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 61 u1: BPM st: NotStopd t0: [06:45:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [06:45:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 78 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [06:45:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [06:45:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [06:45:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [06:45:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 1 u1: BPM st: NotStopd t0: [06:45:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [06:45:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:45:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:45:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:45:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.6 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [08:15:00 13/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [08:15:00 13/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:15:00 13/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [08:15:00 13/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [08:15:00 13/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [08:15:00 13/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:15:00 13/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [08:15:00 13/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 36.2 u1: Deg. C st: NotStopd t0: [08:15:00 13/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:15:00 13/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [08:15:00 13/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [08:15:00 13/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [08:15:00 13/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:15:00 13/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [08:15:00 13/01/2016] id: Peak Flow el: 0 cu: CCU cg: RRT u1: L/m st: NotStopd t0: [08:15:00 13/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [08:15:00 13/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:15:00 13/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [08:15:00 13/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:15:00 13/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:15:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 96 u1: % st: NotStopd t0: [08:15:00 13/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [08:15:00 13/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [08:15:00 13/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [08:15:00 13/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [08:15:00 13/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [08:15:00 13/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 292 u1: ml/B st: NotStopd t0: [08:15:00 13/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [08:15:00 13/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd
t0: [07:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [07:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [07:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [07:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 13/01/2016] id: NBP el: 0 cu: CCU cg: RN v1: 104 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [07:00:00 13/01/2016] id: NBP Mean el: 0 cu: CCU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [07:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 106 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [07:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [07:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [07:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [07:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [07:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 13/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 13/01/2016] id: Pain Level el: 0 cu: CCU cg: RN v1: 6-Mod to Severe st: NotStopd t0: [08:00:00 13/01/2016] id: Pain Level/Response el: 0 cu: CCU cg: RN v1: 4-Mild to Mod st: NotStopd t0: [08:00:00 13/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 13/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 13/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 13/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [08:00:00 13/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 13/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 13/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 13/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 13/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 13/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [08:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 13/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 13/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [08:00:00 13/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 13/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 13/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 13/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [08:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 13/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 13/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 13/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 13/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 13/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 13/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [08:00:00 13/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 13/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 13/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 13/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 13/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [08:00:00 13/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 13/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 13/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 85 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [08:00:00 13/01/2016] id: Pain Cause el: 0 cu: CCU cg: RN v1: At Rest st: NotStopd t0: [08:00:00 13/01/2016] id: Pain Level (Rest) el: 0 cu: CCU cg: RN v1: 6-Mod to Severe st: NotStopd t0: [08:00:00 13/01/2016] id: Pain Management el: 1 cu: CCU cg: RN v1: IV Gtt v2: IV Gtt st: NotStopd t0: [08:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [08:00:00 13/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 13/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 13/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:00:00 13/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [08:00:00 13/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 13/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 13/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [08:00:00 13/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 13/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 13/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 13/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [08:00:00 13/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 13/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [08:00:00 13/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [08:00:00 13/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [08:00:00 13/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 13/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 13/01/2016] id: WarmingDevice/Status el: 0 cu: CCU cg: RN v1: Bair Hugger v2: On st: NotStopd t0: [08:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 13/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [09:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [09:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [09:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 89 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [09:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [09:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [09:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [09:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 15.5925 vu: ml t0: [08:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 10 vu: ml t0: [08:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 8 vu: ml t0: [09:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 12.375 vu: ml t0: [09:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [09:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [07:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.6 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.75 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [09:44:00 13/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.35 rs: Final st: NotStopd t0: [09:44:00 13/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 63 rs: Final st: NotStopd t0: [09:44:00 13/01/2016] id: Lactic Acid Chemistry el: 0 cu: CCU cg: 140 v1: 1.2 rs: Final st: NotStopd t0: [09:44:00 13/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 0 rs: Final st: NotStopd t0: [09:44:00 13/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 27 rs: Final st: NotStopd t0: [09:44:00 13/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 47 u1: mmHg rs: Final st: NotStopd t0: [09:44:00 13/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 96 u1: mmHg rs: Final st: NotStopd t0: [09:44:00 13/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.35 rs: Final st: NotStopd t0: [09:44:00 13/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 63 rs: Final st: NotStopd t0: [09:44:00 13/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CCU cg: 140 v1: 1.2 rs: Final st: NotStopd
t0: [09:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [08:00:00 13/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 13/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [08:00:00 13/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 13/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 13/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 13/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 13/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 13/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [08:00:00 13/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: CCU cg: RN v1: Wound Cleanser st: NotStopd t0: [08:00:00 13/01/2016] id: ImpSkin Character #1 el: 0 cu: CCU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 13/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 13/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 13/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [08:00:00 13/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CCU cg: RN v1: Pink st: NotStopd t0: [08:00:00 13/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 13/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 13/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 13/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 13/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 13/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 13/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 13/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 13/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 13/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 13/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 13/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 13/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 13/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 13/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 13/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [08:00:00 13/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [08:00:00 13/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 13/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 13/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [08:00:00 13/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
tf: [09:00:00 14/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 10 dn: 1 m1: Cosyntropin v1: 250 u1: mcg tf: [05:00:00 20/01/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Fludrocortisone Acetate v1: 0.1 u1: mg
t0: [11:00:00 13/01/2016] id: Bladder Pressure el: 0 cu: CCU cg: -1 st: D/C'd
t0: [07:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [07:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN u1: BPM st: NotStopd t0: [08:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [08:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN u1: BPM st: NotStopd t0: [09:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [09:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN u1: BPM st: NotStopd t0: [10:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [10:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [10:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [10:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 108 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [10:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [10:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [10:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [10:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [10:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [11:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 23 u1: mmHg st: NotStopd t0: [11:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [11:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [11:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 107 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [11:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [11:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [11:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [11:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 35 u1: BPM st: NotStopd t0: [11:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [11:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [12:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [12:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [12:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [12:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 93 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [12:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [12:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [12:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [12:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 35 u1: BPM st: NotStopd t0: [12:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [12:00:00 13/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [12:00:00 13/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [12:00:00 13/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [12:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [12:00:00 13/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: cowker v1: 92 rs: Manual st: NotStopd
pt: TPN tf: [11:00:00 13/01/2016] pt: IV Piggyback rt: IV fr: Q8H fs: 12, 20, 4 dn: 3 m1: Hydrocortisone Na Succ. v1: 100 u1: mg m2: Syringe v2: 1 u2: SYR tf: [11:00:00 13/01/2016] pt: Unit Dose rt: IV fr: Q8H fs: 12, 20, 4 dn: 3 m1: Hydrocortisone Na Succ. v1: 100 u1: mg tf: [05:00:00 20/01/2016] pt: IV Piggyback rt: IV fr: Q8H fs: 12, 20, 4 dn: 3 m1: Hydrocortisone Na Succ. v1: 100 u1: mg m2: Vial v2: 1 u2: VIAL
t0: [12:00:00 13/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [12:00:00 13/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 13/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [12:00:00 13/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [12:00:00 13/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [12:00:00 13/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 13/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 13/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 36.2 u1: Deg. C st: NotStopd t0: [12:00:00 13/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 13/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [12:00:00 13/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 13/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 13/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [12:00:00 13/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.1 u1: L/min st: NotStopd t0: [12:00:00 13/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 13/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 13/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [12:00:00 13/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [12:00:00 13/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:00:00 13/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [12:00:00 13/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 13/01/2016] id: Sputum Color/Consist el: 0 cu: CCU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [12:00:00 13/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [12:00:00 13/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [12:00:00 13/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [12:00:00 13/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [12:00:00 13/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [12:00:00 13/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [12:00:00 13/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 270 u1: ml/B st: NotStopd t0: [12:00:00 13/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [12:00:00 13/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 13/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: SQUARE st: NotStopd
id: Levophed-k el: 100 cu: CCU cg: RN io: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips am: 8 du: mcgkgmin rt: IV Drip
io: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips el: 1 cu: CCU cg: RN ra: 3 ru: ml/hr
id: D5W el: 1 cu: CCU cg: RN io: D5W 250.0ml + 8mcgkgmin Levophed-k IV Drips vo: 250 du: ml rt: Intravenous Push
t0: [13:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [13:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [13:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [13:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [13:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 102 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [13:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [13:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [13:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [13:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [13:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 40 vu: ml t0: [13:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 40 vu: ml t0: [13:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 66 vu: ml t0: [13:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 20 vu: ml t0: [13:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 16 vu: ml
t0: [13:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 13/01/2016] tf: [18:30:00 19/01/2016] dt: 8970 id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0242424 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 1 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [13:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 35 u1: BPM st: NotStopd
t0: [13:30:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [13:30:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 20 u1: mmHg st: NotStopd t0: [13:30:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [13:30:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [13:30:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:30:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:30:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [13:30:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [13:30:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 95 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [13:30:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [13:30:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [13:30:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [13:30:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [13:30:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:30:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:30:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0242424 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:30:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [13:30:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
id: Levophed-k el: 101 cu: CCU cg: RN io: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions am: 16 du: mcgkgmin rt: IV Drip
tf: [11:00:00 14/01/2016] pt: IV Piggyback rt: IV fr: Q24H fs: 14 dn: 1 m1: Vancomycin HCl v1: 1000 u1: mg m2: Iso-Osmotic Dextrose v2: 200 u2: ml tf: [14:00:00 15/01/2016] pt: IV Piggyback rt: IV fr: Q24H fs: 14 dn: 1 m1: Ceftriaxone v1: 1 u1: gm m2: Iso-Osmotic Dextrose v2: 50 u2: ml
id: D5W el: 1 cu: CCU cg: RN io: D5W 250.0ml + 16mcgkgmin Levophed-k IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [13:30:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN u1: BPM st: NotStopd t0: [14:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 41 u1: BPM st: NotStopd
t0: [14:00:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0484849 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [14:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [14:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [14:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 83 u1: BPM st: NotStopd t0: [14:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 85 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [14:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [14:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [14:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [14:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 8.25 vu: ml t0: [14:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [14:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [14:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [14:30:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [14:30:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [14:30:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:30:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:30:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:30:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:30:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 88 u1: BPM st: NotStopd t0: [14:30:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [14:30:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 129 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [14:30:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [14:30:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:30:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [14:30:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 44 u1: BPM st: NotStopd t0: [14:30:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [14:30:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:30:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:30:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0646465 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:30:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:30:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [15:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 49 u1: BPM st: NotStopd
t0: [15:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 0 vu: ml t0: [15:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [15:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4.5 vu: ml
t0: [15:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [15:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 19 u1: mmHg st: NotStopd t0: [15:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [15:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 99 u1: BPM st: NotStopd t0: [15:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 120 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [15:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [15:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [15:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [15:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [15:00:00 13/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [15:00:00 13/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 38.1111 u1: Deg. C st: NotStopd t0: [15:00:00 13/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 100.6 u1: Deg. F st: NotStopd t0: [15:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0565657 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [16:00:00 13/01/2016] id: Cuff Pressure-Airway el: 0 cu: CCU cg: RRT u1: cmH2O st: NotStopd t0: [16:00:00 13/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [16:00:00 13/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 13/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [16:00:00 13/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [16:00:00 13/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [16:00:00 13/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:00:00 13/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [16:00:00 13/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 13/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 13/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [16:00:00 13/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 13/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 13/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:00:00 13/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 14 u1: L/min st: NotStopd t0: [16:00:00 13/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 13/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 13/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [16:00:00 13/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [16:00:00 13/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 49 u1: BPM st: NotStopd t0: [16:00:00 13/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [16:00:00 13/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 97 u1: % st: NotStopd t0: [16:00:00 13/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [16:00:00 13/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [16:00:00 13/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [16:00:00 13/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [16:00:00 13/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 13 st: NotStopd t0: [16:00:00 13/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 285 u1: ml/B st: NotStopd t0: [16:00:00 13/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [16:00:00 13/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 13/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: SQUARE st: NotStopd
tf: [18:00:00 13/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 16 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [15:00:00 14/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 16 dn: 1 m1: Albumin 25% (12.5gm) v1: 25 u1: gm tf: [09:00:00 27/01/2016] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Humulin-R Insulin v1: 100 u1: UNIT m2: NS v2: 100 u2: ml
t0: [16:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [16:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 115 u1: BPM st: NotStopd t0: [16:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 157 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [16:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [16:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [16:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [16:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 38 u1: BPM st: NotStopd t0: [16:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 0 vu: ml t0: [16:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [16:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [16:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0565657 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [16:00:00 13/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 106 rs: Manual st: NotStopd
t0: [17:00:00 13/01/2016] id: WarmingDevice/Status el: 0 cu: CCU cg: -1 st: D/C'd
t0: [08:00:00 13/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 13/01/2016] id: PostTib. Pulses R/L el: 0 cu: CCU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 13/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [12:00:00 13/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 13/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 13/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 13/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [12:00:00 13/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 13/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [12:00:00 13/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 13/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [12:00:00 13/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [12:00:00 13/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [12:00:00 13/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [16:00:00 13/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 13/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [16:00:00 13/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [16:00:00 13/01/2016] id: Pain Present el: 0 cu: CCU cg: RN st: NotStopd t0: [16:00:00 13/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Grimace Scale st: NotStopd t0: [16:00:00 13/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 13/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 13/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 13/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 13/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [16:00:00 13/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 13/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [16:00:00 13/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [16:00:00 13/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [16:00:00 13/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 8 u1: points st: NotStopd t0: [16:00:00 13/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 13/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 13/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 13/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 13/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 13/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 13/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 13/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 13/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 13/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [16:00:00 13/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 13/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 13/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Pain st: NotStopd t0: [16:00:00 13/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [16:00:00 13/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 13/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 13/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 13/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 13/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 13/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [16:00:00 13/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [16:00:00 13/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 13/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [16:00:00 13/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 13/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 13/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 13/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 13/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 13/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 13/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 13/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 13/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [16:00:00 13/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [16:00:00 13/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [16:00:00 13/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 13/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [16:00:00 13/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [16:00:00 13/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [16:00:00 13/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [17:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [17:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [17:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 96 u1: BPM st: NotStopd t0: [17:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 122 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [17:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [17:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [17:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 48 u1: BPM st: NotStopd t0: [17:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [17:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 0 vu: ml t0: [17:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [17:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3.5 vu: ml
t0: [17:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0484849 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [18:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [18:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [18:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [18:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 100 u1: BPM st: NotStopd t0: [18:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 155 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [18:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [18:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [18:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 8 u1: BPM st: NotStopd t0: [18:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [18:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [18:00:00 13/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: Flat in Bed st: NotStopd t0: [18:00:00 13/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 13/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 13/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 13/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [18:00:00 13/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 13/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [18:00:00 13/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd
t0: [19:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd
t0: [19:00:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0646465 du: mcgkgmin sv: 250 su: ml rt: IV Drip
tf: [18:00:00 14/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 19 dn: 1 m1: Potassium Chloride v1: 20 u1: mEq m2: SW v2: 50 u2: ml
t0: [12:40:00 13/01/2016] id: Albumin Chemistry el: 0 cu: CCU cg: 140 v1: 2.9 rs: Final st: NotStopd t0: [12:40:00 13/01/2016] id: Total Bili Chemistry el: 0 cu: CCU cg: 140 v1: 1.5 rs: Final st: NotStopd t0: [12:40:00 13/01/2016] id: Total Protein Chemistry el: 0 cu: CCU cg: 140 v1: 5.6 rs: Final st: NotStopd t0: [12:40:00 13/01/2016] id: ALT Enzymes el: 0 cu: CCU cg: 140 v1: 8 rs: Final st: NotStopd t0: [12:40:00 13/01/2016] id: AST Enzymes el: 0 cu: CCU cg: 140 v1: 11 rs: Final st: NotStopd t0: [12:40:00 13/01/2016] id: Albumin (>3.2) Chemistry el: 0 cu: CCU cg: 140 v1: 2.9 rs: Final st: NotStopd t0: [12:40:00 13/01/2016] id: Alk. Phosphate Enzymes el: 0 cu: CCU cg: 140 v1: 66 rs: Final st: NotStopd t0: [12:40:00 13/01/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: CCU cg: 140 v1: 1.5 rs: Final st: NotStopd t0: [12:40:00 13/01/2016] id: Total Protein(6.5-8) Chemistry el: 0 cu: CCU cg: 140 v1: 5.6 rs: Final st: NotStopd
t0: [19:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [19:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [19:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [19:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 88 u1: BPM st: NotStopd t0: [19:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 115 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [19:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [19:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [19:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [19:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [19:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [19:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [19:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [19:00:00 13/01/2016] id: D5W 250.0ml + 60mcgkgmin Neosynephrine-k IV Infusions el: 1 cu: CCU cg: RN ai: 199 vo: 0 vu: ml t0: [19:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 10 vu: ml t0: [19:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 8 vu: ml
t0: [19:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 13/01/2016] id: Neosynephrine-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [19:00:00 13/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 102 rs: Manual st: NotStopd
t0: [20:00:00 13/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: 1341 v1: 25cm v2: Lip st: NotStopd t0: [20:00:00 13/01/2016] id: FiO2 Set el: 0 cu: CCU cg: 1341 v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 13/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: 1341 v1: 36 u1: cmH2O st: NotStopd t0: [20:00:00 13/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: 1341 v1: 10 u1: BPM st: NotStopd t0: [20:00:00 13/01/2016] id: I:E Ratio el: 0 cu: CCU cg: 1341 v1: 1:3 st: NotStopd t0: [20:00:00 13/01/2016] id: Airway Size el: 0 cu: CCU cg: 1341 v1: 7.5 mm st: NotStopd t0: [20:00:00 13/01/2016] id: Airway Type el: 0 cu: CCU cg: 1341 v1: Endotracheal st: NotStopd t0: [20:00:00 13/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: 1341 v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 13/01/2016] id: Intubation Date el: 0 cu: CCU cg: 1341 v1: 12 v2: 23 st: NotStopd t0: [20:00:00 13/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: 1341 v1: 8 st: NotStopd t0: [20:00:00 13/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: 1341 v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 13/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: 1341 v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 13/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: 1341 v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 13/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: 1341 v1: 14.5 u1: L/min st: NotStopd t0: [20:00:00 13/01/2016] id: PEEP Set el: 0 cu: CCU cg: 1341 v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 13/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: 1341 v1: 20 st: NotStopd t0: [20:00:00 13/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: 1341 v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 13/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: 1341 v1: 17 u1: BPM st: NotStopd t0: [20:00:00 13/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: 1341 v1: 47 u1: BPM st: NotStopd t0: [20:00:00 13/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: 1341 v1: 30 u1: BPM st: NotStopd t0: [20:00:00 13/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: 1341 v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: 1341 v1: 97 u1: % st: NotStopd t0: [20:00:00 13/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: 1341 v1: Insp. Time Fixed st: NotStopd t0: [20:00:00 13/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: 1341 v1: 1:3 st: NotStopd t0: [20:00:00 13/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: 1341 v1: 23 u1: cmH2O st: NotStopd t0: [20:00:00 13/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: 1341 v1: 0.5 u1: sec st: NotStopd t0: [20:00:00 13/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: 1341 v1: 13 st: NotStopd t0: [20:00:00 13/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: 1341 v1: 313 u1: ml/B st: NotStopd t0: [20:00:00 13/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: 1341 v1: Pressure Control st: NotStopd t0: [20:00:00 13/01/2016] id: Ventilator Type el: 0 cu: CCU cg: 1341 v1: Drager st: NotStopd t0: [20:00:00 13/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: 1341 v1: SQUARE st: NotStopd
id: Levophed-k el: 100 cu: CCU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions am: 4 du: mg rt: IV Drip
id: D5W el: 1 cu: CCU cg: RN io: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions vo: 250 du: ml rt: Intravenous Push id: TPN el: 1 cu: CCU cg: RN io: TPN 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push
t0: [18:00:00 13/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [18:00:00 13/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [18:00:00 13/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [18:00:00 13/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [18:00:00 13/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [18:00:00 13/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [18:00:00 13/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 13/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 13/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 13/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 13/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 13/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 13/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [20:00:00 13/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 13/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [20:00:00 13/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [20:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 16 u1: mmHg st: NotStopd t0: [20:00:00 13/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 13/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 13/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 13/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 13/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 13/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [20:00:00 13/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 13/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 13/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [20:00:00 13/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [20:00:00 13/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Consistently st: NotStopd t0: [20:00:00 13/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 8 u1: points st: NotStopd t0: [20:00:00 13/01/2016] id: GI Guaiac/ph el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [20:00:00 13/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 13/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [20:00:00 13/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 13/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 13/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 95 u1: BPM st: NotStopd t0: [20:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 13/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: Flat in Bed st: NotStopd t0: [20:00:00 13/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 13/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 13/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 13/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 13/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 13/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 13/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 13/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [20:00:00 13/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 13/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 13/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 13/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 13/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 13/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [20:00:00 13/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 13/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 13/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Crackles st: NotStopd t0: [20:00:00 13/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [20:00:00 13/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Pain st: NotStopd t0: [20:00:00 13/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 13/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 13/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 128 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [20:00:00 13/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [20:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [20:00:00 13/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 13/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [20:00:00 13/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 13/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [20:00:00 13/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 13/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [20:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [20:00:00 13/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 13/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 13/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 13/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 13/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [20:00:00 13/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [20:00:00 13/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 13/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 13/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 13/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 13/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [20:00:00 13/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [20:00:00 13/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 13/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 13/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [20:00:00 13/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [21:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [21:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 18 u1: mmHg st: NotStopd t0: [21:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 13/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: Flat in Bed st: NotStopd t0: [21:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 94 u1: BPM st: NotStopd t0: [21:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 13/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 13/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 13/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 134 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [21:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [21:00:00 13/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [21:00:00 13/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [21:00:00 13/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [21:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [21:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [21:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [21:00:00 13/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd t0: [21:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 13/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 20 vu: ml t0: [20:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 13/01/2016] tf: [18:30:00 19/01/2016] dt: 8490 id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 0 vu: ml nb: 1 t0: [20:00:00 13/01/2016] tf: [08:00:00 14/01/2016] dt: 720 id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 3 vu: ml t0: [20:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [20:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml t0: [21:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 13/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [21:00:00 13/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 3 vu: ml t0: [21:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [21:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [20:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0484849 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0484849 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 13/01/2016] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: RN cv: 60 ap: none
t0: [22:00:00 13/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 104 rs: Manual st: NotStopd
t0: [22:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [22:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [22:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 93 u1: BPM st: NotStopd t0: [22:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 146 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [22:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [22:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [22:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [22:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [22:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0484849 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:11:00 13/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.48 rs: Final st: NotStopd t0: [22:11:00 13/01/2016] id: CaO2 el: 0 cu: CCU cg: 140 v1: 14.0034 u1: ml/dl st: NotStopd t0: [22:11:00 13/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 0 rs: Final st: NotStopd t0: [22:11:00 13/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 23 rs: Final st: NotStopd t0: [22:11:00 13/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 30 u1: mmHg rs: Final st: NotStopd t0: [22:11:00 13/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 154 u1: mmHg rs: Final st: NotStopd t0: [22:11:00 13/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.48 rs: Final st: NotStopd t0: [22:11:00 13/01/2016] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 98 u1: % rs: Final st: NotStopd
t0: [23:00:00 13/01/2016] id: Service Type el: 0 cu: CCU cg: RRT v1: MICU st: NotStopd t0: [23:00:00 13/01/2016] id: CVP el: 0 cu: CCU cg: RRT v1: 8 u1: mmHg st: NotStopd t0: [23:00:00 13/01/2016] id: Code Status el: 0 cu: CCU cg: RRT v1: Full Code st: NotStopd t0: [23:00:00 13/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RRT v1: Yes st: NotStopd t0: [23:00:00 13/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RRT v1: None st: NotStopd t0: [23:00:00 13/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RRT v1: None st: NotStopd t0: [23:00:00 13/01/2016] id: Heart Rate el: 0 cu: CCU cg: RRT v1: 92 u1: BPM st: NotStopd t0: [23:00:00 13/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RRT v1: Normal Sinus st: NotStopd t0: [23:00:00 13/01/2016] id: Arterial BP el: 0 cu: CCU cg: RRT v1: 146 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [23:00:00 13/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RRT v1: 103 u1: mmHg st: NotStopd t0: [23:00:00 13/01/2016] id: Precautions el: 0 cu: CCU cg: RRT v1: Universal st: NotStopd t0: [23:00:00 13/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RRT v1: 66 u1: kg st: NotStopd t0: [23:00:00 13/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [23:00:00 13/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 97 u1: % st: NotStopd t0: [23:00:00 13/01/2016] id: calprevflg el: 0 cu: CCU cg: RRT v1: 1 u1: kg st: NotStopd
t0: [23:00:00 13/01/2016] id: Fentanyl el: 1 cu: CCU cg: RRT so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 13/01/2016] id: Levophed-k el: 1 cu: CCU cg: RRT so: D5W vo: 0 v1: 0.0484849 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 13/01/2016] id: Midazolam el: 1 cu: CCU cg: RRT so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 161 rs: Manual st: NotStopd
id: Insulin el: 100 cu: CCU cg: RN io: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions am: 100 du: U rt: IV Drip
t0: [00:00:00 14/01/2016] id: Energy Expenditure el: 0 cu: CCU cg: -1 st: D/C'd t0: [00:00:00 14/01/2016] id: Resp Quotient - (R) el: 0 cu: CCU cg: -1 st: D/C'd t0: [00:00:00 14/01/2016] id: VCO2 (180-200) el: 0 cu: CCU cg: -1 st: D/C'd t0: [00:00:00 14/01/2016] id: VO2 (200-250) el: 0 cu: CCU cg: -1 st: D/C'd t0: [00:00:00 14/01/2016] id: Vd/Vt Ratio (40-60%) el: 0 cu: CCU cg: -1 st: D/C'd
io: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ra: 1 ru: ml/hr
id: .9% Normal Saline el: 1 cu: CCU cg: RN io: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions vo: 100 du: ml rt: Intravenous Push
t0: [20:00:00 13/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Axillary st: NotStopd t0: [23:00:00 13/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Axillary st: NotStopd t0: [23:00:00 13/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.3889 u1: Deg. C st: NotStopd t0: [23:00:00 13/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 99.3 u1: Deg. F st: NotStopd t0: [00:00:00 14/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [00:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [00:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [00:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 14/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 14/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 88 u1: BPM st: NotStopd t0: [00:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 124 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [00:00:00 14/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [00:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:00:00 14/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [00:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [00:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 13/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [22:00:00 13/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 3 vu: ml t0: [22:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [22:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml t0: [23:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 13/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 13/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [23:00:00 13/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 3 vu: ml t0: [23:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [23:00:00 13/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml t0: [00:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [00:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 0 vu: ml nb: 1 t0: [00:00:00 14/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 3 vu: ml t0: [00:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [00:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [00:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0484849 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 14/01/2016] tf: [18:30:00 19/01/2016] dt: 8310 id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [00:00:00 14/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [00:00:00 14/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 14/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [00:00:00 14/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [00:00:00 14/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [00:00:00 14/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 14/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 14/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35.4 u1: Deg. C st: NotStopd t0: [00:00:00 14/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 14/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [00:00:00 14/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 14/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 14/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 14/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [00:00:00 14/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 14/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 14/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 14/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [00:00:00 14/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 14/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 14/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 14/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [00:00:00 14/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [00:00:00 14/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [00:00:00 14/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [00:00:00 14/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [00:00:00 14/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [00:00:00 14/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 14/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [00:47:00 14/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.38 rs: Final st: NotStopd t0: [00:47:00 14/01/2016] id: CaO2 el: 0 cu: CCU cg: 140 v1: 13.8529 u1: ml/dl st: NotStopd t0: [00:47:00 14/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 0 rs: Final st: NotStopd t0: [00:47:00 14/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 26 rs: Final st: NotStopd t0: [00:47:00 14/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 43 u1: mmHg rs: Final st: NotStopd t0: [00:47:00 14/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 150 u1: mmHg rs: Final st: NotStopd t0: [00:47:00 14/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.38 rs: Final st: NotStopd t0: [00:47:00 14/01/2016] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 97 u1: % rs: Final st: NotStopd
t0: [20:00:00 13/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [20:00:00 13/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 13/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 13/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 13/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 13/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 13/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 13/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [20:00:00 13/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 13/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [00:00:00 14/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 14/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [00:00:00 14/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 14/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 14/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 14/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 14/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 14/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [00:00:00 14/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 14/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [00:00:00 14/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 14/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 14/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 14/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 14/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: Flat in Bed st: NotStopd t0: [00:00:00 14/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: Flat in Bed st: NotStopd t0: [00:00:00 14/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 14/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 14/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 14/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 14/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 14/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [00:00:00 14/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [00:00:00 14/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 14/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 14/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 14/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 14/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 14/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 14/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 14/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [00:00:00 14/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [00:00:00 14/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 14/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 14/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 14/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Crackles st: NotStopd t0: [00:00:00 14/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [00:00:00 14/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 14/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 14/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 14/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 14/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [00:00:00 14/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 14/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 14/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 14/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [00:00:00 14/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 14/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [00:00:00 14/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 14/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [00:00:00 14/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 14/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 14/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 14/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 14/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd t0: [00:00:00 14/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 14/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 14/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 14/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [00:00:00 14/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 14/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 14/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 14/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 14/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 14/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [00:00:00 14/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 14/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [00:00:00 14/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [00:00:00 14/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 14/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [00:00:00 14/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 14/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [00:00:00 14/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [01:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [01:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [01:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 87 u1: BPM st: NotStopd t0: [01:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 120 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [01:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [01:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:00:00 14/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [01:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 21 u1: BPM st: NotStopd t0: [01:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [01:00:00 14/01/2016] tf: [16:00:00 17/01/2016] dt: 5220 id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [01:00:00 14/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 3 vu: ml t0: [01:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [01:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [01:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0484849 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [01:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [01:44:00 14/01/2016] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CCU cg: 140 v1: 83 rs: Final st: NotStopd
t0: [00:47:00 14/01/2016] id: DO2I el: 0 cu: CCU cg: RN v1: 908.6 u1: ml/m/m st: NotStopd t0: [01:00:00 14/01/2016] id: Cardiac Index el: 0 cu: CCU cg: RN v1: 6.49123 u1: ... st: NotStopd t0: [01:00:00 14/01/2016] tf: [11:00:00 14/01/2016] dt: 600 id: SVR el: 0 cu: CCU cg: RN v1: 540.541 u1: ... st: NotStopd t0: [01:00:00 14/01/2016] tf: [18:30:00 19/01/2016] dt: 8250 id: SVRI el: 0 cu: CCU cg: RN v1: 924.499 u1: ... st: NotStopd t0: [01:00:00 14/01/2016] id: Hematocrit Hematology el: 0 cu: CCU cg: RN v1: 33.3 u1: % rs: Manual st: NotStopd t0: [01:00:00 14/01/2016] id: Hemoglobin Hematology el: 0 cu: CCU cg: RN v1: 10.3 u1: gm/dl rs: Manual st: NotStopd t0: [01:00:00 14/01/2016] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CCU cg: RN v1: 83 rs: Manual st: NotStopd t0: [01:00:00 14/01/2016] id: SaO2 ABG's el: 0 cu: CCU cg: RN v1: 97 u1: % rs: Manual st: NotStopd t0: [01:00:00 14/01/2016] id: C.O. (fick) el: 0 cu: CCU cg: RN v1: 11.0621 u1: L/min st: NotStopd t0: [01:44:00 14/01/2016] id: Cardiac Index el: 0 cu: CCU cg: RN v1: 6.49123 u1: ... st: NotStopd t0: [01:44:00 14/01/2016] id: C.O. (fick) el: 0 cu: CCU cg: RN v1: 11.0621 u1: L/min st: NotStopd t0: [02:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [02:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [02:00:00 14/01/2016] id: Cardiac Index el: 0 cu: CCU cg: RN v1: 6.49123 u1: ... st: NotStopd t0: [02:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [02:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 83 u1: BPM st: NotStopd t0: [02:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 102 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [02:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [02:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [02:00:00 14/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [02:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 3 u1: BPM st: NotStopd t0: [02:00:00 14/01/2016] id: SVRI el: 0 cu: CCU cg: RN v1: 801.233 u1: ... st: NotStopd t0: [02:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWkr v1: 154 rs: Manual st: NotStopd
t0: [02:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [02:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [02:00:00 14/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 3 vu: ml t0: [02:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [02:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [02:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 14/01/2016] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN cv: 0 ap: none t0: [23:00:00 14/01/2016] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN pv: 273.5 cv: 273.5 ap: none t0: [23:00:00 14/01/2016] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN pv: 218.5 cv: 2189 ap: none t0: [23:00:00 14/01/2016] dt: 24 id: IV Nutrition Total el: 1 cu: CCU cg: RN pv: 45 cv: 1080 ap: none t0: [23:00:00 14/01/2016] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN pv: 273.5 cv: 3484 ap: none t0: [23:00:00 14/01/2016] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN cv: 404 ap: none t0: [23:00:00 14/01/2016] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN pv: 273.5 cv: 3055 ap: none t0: [23:00:00 14/01/2016] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN cv: 429 ap: none t0: [23:00:00 14/01/2016] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN pv: 273.5 cv: 12423.4 ap: carryForward
t0: [01:44:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [01:44:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [01:44:00 14/01/2016] id: SVR el: 0 cu: CCU cg: RN v1: 540.541 u1: ... st: NotStopd t0: [01:44:00 14/01/2016] id: SVRI el: 0 cu: CCU cg: RN v1: 924.499 u1: ... st: NotStopd
t0: [02:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [02:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [04:00:00 14/01/2016] id: RSBI Not Completed el: 0 cu: CCU cg: RRT v1: Other/Remarks st: NotStopd t0: [04:00:00 14/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [04:00:00 14/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 14/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [04:00:00 14/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [04:00:00 14/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [04:00:00 14/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 14/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 14/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35.5 u1: Deg. C st: NotStopd t0: [04:00:00 14/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 14/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [04:00:00 14/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 14/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [04:00:00 14/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 14/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 14/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 14/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 14/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 14/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 14/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 98 u1: % st: NotStopd t0: [04:00:00 14/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [04:00:00 14/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [04:00:00 14/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [04:00:00 14/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [04:00:00 14/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [04:00:00 14/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [04:00:00 14/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 14/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 14/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 14/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Consistently st: NotStopd t0: [00:00:00 14/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 9 u1: points st: NotStopd t0: [00:00:00 14/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 14/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 14/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 14/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [00:00:00 14/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 14/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 14/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [03:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [03:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [03:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [03:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 80 u1: BPM st: NotStopd t0: [03:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [03:00:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 29 u1: mmHg v2: 18 u2: mmHg st: NotStopd t0: [03:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 118 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [03:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [03:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [03:00:00 14/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [03:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [03:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 14/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 14/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [04:00:00 14/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 14/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [04:00:00 14/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [04:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 7 u1: mmHg st: NotStopd t0: [04:00:00 14/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 14/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 14/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 14/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 14/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 14/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: NPO st: NotStopd t0: [04:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 14/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 14/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [04:00:00 14/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 14/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Consistently st: NotStopd t0: [04:00:00 14/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 9 u1: points st: NotStopd t0: [04:00:00 14/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 14/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 14/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 14/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 14/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 79 u1: BPM st: NotStopd t0: [04:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 14/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 14/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 14/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 14/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 14/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 14/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 14/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [04:00:00 14/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 14/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [04:00:00 14/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 14/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 14/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 14/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 14/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 14/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 14/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 14/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 14/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [04:00:00 14/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 14/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [04:00:00 14/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [04:00:00 14/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 14/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 14/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 14/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 14/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [04:00:00 14/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 14/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [04:00:00 14/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 14/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [04:00:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 29 u1: mmHg v2: 19 u2: mmHg st: NotStopd t0: [04:00:00 14/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 120 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [04:00:00 14/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [04:00:00 14/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 14/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:00:00 14/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [04:00:00 14/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [04:00:00 14/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [04:00:00 14/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [04:00:00 14/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 14/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [04:00:00 14/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 14/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [04:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [04:00:00 14/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 14/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 14/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 14/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 14/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 14/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 14/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 14/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 14/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 14/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 14/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [04:00:00 14/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 14/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 14/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 14/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 14/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 14/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [04:00:00 14/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 14/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [04:00:00 14/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [04:00:00 14/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 14/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [04:00:00 14/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 14/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [04:00:00 14/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [03:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [03:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [03:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [03:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml t0: [04:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [04:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [04:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [03:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.04 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [03:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [04:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [03:00:00 14/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 2.5 vu: ml t0: [04:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 3 vu: ml t0: [04:00:00 14/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 2 vu: ml t0: [05:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [05:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 3 vu: ml t0: [05:00:00 14/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 2 vu: ml t0: [05:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [05:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [04:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0323232 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [04:00:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 155 rs: Manual st: NotStopd
t0: [04:00:00 14/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 14/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [04:00:00 14/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 98.4 u1: Deg. F st: NotStopd
t0: [05:40:00 14/01/2016] id: Mixed Venous O2% Sat Blood Gases el: 0 cu: CCU cg: 140 v1: 88 rs: Final st: NotStopd
t0: [06:00:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWkr v1: 158 rs: Manual st: NotStopd
t0: [05:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [05:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [05:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 78 u1: BPM st: NotStopd t0: [05:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [05:00:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 26 u1: mmHg v2: 16 u2: mmHg st: NotStopd t0: [05:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 114 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [05:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [05:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:00:00 14/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [05:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [05:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 14/01/2016] id: Hemoglobin Hematology el: 0 cu: CCU cg: RN v1: 10.3 u1: gm/dl rs: Manual st: NotStopd t0: [06:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [06:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 6 u1: mmHg st: NotStopd t0: [06:00:00 14/01/2016] id: Cardiac Index el: 0 cu: CCU cg: RN v1: 9.06433 u1: ... st: NotStopd t0: [06:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [06:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 77 u1: BPM st: NotStopd t0: [06:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: RN v1: 21 u1: mmHg st: NotStopd t0: [06:00:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 26 u1: mmHg v2: 16 u2: mmHg st: NotStopd t0: [06:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 116 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [06:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [06:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [06:00:00 14/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [06:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [06:00:00 14/01/2016] id: SVRI el: 0 cu: CCU cg: RN v1: 653.422 u1: ... st: NotStopd t0: [06:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [06:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0323232 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [05:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip t0: [06:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 250 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0323232 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [06:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [05:00:00 14/01/2016] id: Hematocrit Hematology el: 0 cu: CCU cg: RN v1: 33.3 u1: % rs: Manual st: NotStopd
t0: [06:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [06:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [06:00:00 14/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 2 vu: ml t0: [06:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [06:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [06:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [05:30:00 14/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 12.9 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 12.9 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 31.7 u1: % rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 9.9 u1: gm/dl rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 304 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 3.32 u1: /mic l rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 12.9 rs: Final st: NotStopd t0: [05:40:00 14/01/2016] id: Cardiac Index el: 0 cu: CCU cg: 140 v1: 9.4152 u1: ... st: NotStopd t0: [05:40:00 14/01/2016] id: C.O. (fick) el: 0 cu: CCU cg: 140 v1: 16.1126 u1: L/min st: NotStopd
t0: [05:30:00 14/01/2016] id: PT el: 0 cu: CCU cg: 140 v1: 15.1 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: INR Coags el: 0 cu: CCU cg: 140 v1: 1.5 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: PTT Coags el: 0 cu: CCU cg: 140 v1: 38.7 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CCU cg: 140 v1: 1.5 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: PT(11-13.5) Coags el: 0 cu: CCU cg: 140 v1: 15.1 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: PTT(22-35) Coags el: 0 cu: CCU cg: 140 v1: 38.7 rs: Final st: NotStopd
t0: [05:30:00 14/01/2016] id: BUN el: 0 cu: CCU cg: 140 v1: 61 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 109 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 2.6 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 136 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 2.3 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 6.1 u1: mEq/L rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 4.3 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 145 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 61 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 26 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 109 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 2.6 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 136 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 2.3 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 6.1 u1: mEq/L rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 4.3 rs: Final st: NotStopd t0: [05:30:00 14/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 145 rs: Final st: NotStopd
t0: [07:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [07:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 9 u1: mmHg st: NotStopd t0: [07:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [07:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 78 u1: BPM st: NotStopd t0: [07:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: RN v1: 24 u1: mmHg st: NotStopd t0: [07:00:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 33 u1: mmHg v2: 17 u2: mmHg st: NotStopd t0: [07:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 112 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [07:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [07:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [07:00:00 14/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 66 u1: kg st: NotStopd t0: [07:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [07:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [07:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [07:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [07:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [07:00:00 14/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: RN ai: 210 vo: 2 vu: ml t0: [07:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [07:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0.0323232 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [07:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 14/01/2016] dt: 24 id: Chest Tube Out Total el: 1 cu: CCU cg: RN cv: 25 ap: none
t0: [07:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml
t0: [07:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 14/01/2016] id: D5W 250.0ml + 4mcgkgmin Levophed-k IV Infusions el: 1 cu: CCU cg: -1 ai: 210 vo: 0 st: D/C'd
t0: [08:00:00 14/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [08:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 17 u1: mmHg st: NotStopd t0: [08:00:00 14/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 14/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 14/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 14/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [08:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 14/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [08:00:00 14/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 8 u1: points st: NotStopd t0: [08:00:00 14/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 14/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 14/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 14/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 78 u1: BPM st: NotStopd t0: [08:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 14/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Pain st: NotStopd t0: [08:00:00 14/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 14/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 14/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: RN v1: 34 u1: mmHg st: NotStopd t0: [08:00:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 40 u1: mmHg v2: 30 u2: mmHg st: NotStopd t0: [08:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 111 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [08:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [08:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:00:00 14/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [08:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [08:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 14/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [08:00:00 14/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [08:00:00 14/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [08:00:00 14/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 14/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 14/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 14/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [08:00:00 14/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 14/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 14/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [08:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [08:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [08:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [08:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [08:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [08:00:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 134 rs: Manual st: NotStopd
t0: [08:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip
t0: [08:00:00 14/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [08:00:00 14/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 14/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [08:00:00 14/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 14/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [08:00:00 14/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 14/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 14/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 14/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 14/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [08:00:00 14/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 14/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 14/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 14/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.4 u1: L/min st: NotStopd t0: [08:00:00 14/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 14/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 14/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [08:00:00 14/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [08:00:00 14/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 14/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 14/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 14/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [08:00:00 14/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [08:00:00 14/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [08:00:00 14/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [08:00:00 14/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 317 u1: ml/B st: NotStopd t0: [08:00:00 14/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [08:00:00 14/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 14/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [08:30:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [08:30:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [08:30:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:30:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:30:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:30:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [08:30:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:30:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: RN v1: 29 u1: mmHg st: NotStopd t0: [08:30:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 33 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [08:30:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 95 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [08:30:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [08:30:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:30:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 20 u1: BPM st: NotStopd t0: [08:30:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [08:30:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [09:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [09:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 64 u1: BPM st: NotStopd t0: [09:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [09:00:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 31 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [09:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 89 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [09:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [09:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:30:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [09:30:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [09:30:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:30:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 61 u1: BPM st: NotStopd t0: [09:30:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [09:30:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: RN v1: 28 u1: mmHg st: NotStopd t0: [09:30:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 31 u1: mmHg v2: 23 u2: mmHg st: NotStopd t0: [09:30:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 91 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [09:30:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [09:30:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:30:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [09:30:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [09:30:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:30:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:30:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [08:30:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:30:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip t0: [09:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip t0: [09:30:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:30:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [09:30:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [09:30:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [10:00:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: cowker v1: 113 rs: Manual st: NotStopd
t0: [11:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: -1 st: D/C'd t0: [11:00:00 14/01/2016] id: Cardiac Index el: 0 cu: CCU cg: -1 st: D/C'd t0: [11:00:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: -1 st: D/C'd t0: [11:00:00 14/01/2016] id: SVR el: 0 cu: CCU cg: -1 st: D/C'd t0: [11:00:00 14/01/2016] id: C.O. (fick) el: 0 cu: CCU cg: -1 st: D/C'd
t0: [11:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: -1 ai: 107 vo: 0 st: D/C'd
t0: [08:00:00 14/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [08:00:00 14/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 14/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [08:00:00 14/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 14/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [08:00:00 14/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [08:00:00 14/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [08:00:00 14/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [10:00:00 14/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [10:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [10:00:00 14/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [10:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 14/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 60 u1: BPM st: NotStopd t0: [10:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [10:00:00 14/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [10:00:00 14/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [10:00:00 14/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 14/01/2016] id: PAP Mean el: 0 cu: CCU cg: RN v1: 27 u1: mmHg st: NotStopd t0: [10:00:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 30 u1: mmHg v2: 22 u2: mmHg st: NotStopd t0: [10:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 88 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [10:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [10:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 19 u1: BPM st: NotStopd t0: [10:00:00 14/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 14/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [11:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [11:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 14/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [11:00:00 14/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [11:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 59 u1: BPM st: NotStopd t0: [11:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [11:00:00 14/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [11:00:00 14/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [11:00:00 14/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [11:00:00 14/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [11:00:00 14/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [11:00:00 14/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 14/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [11:00:00 14/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [11:00:00 14/01/2016] id: PAP S/D el: 0 cu: CCU cg: RN v1: 0 u1: mmHg v2: 0 u2: mmHg st: NotStopd t0: [11:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 92 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [11:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [11:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [11:00:00 14/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [11:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 23 u1: BPM st: NotStopd t0: [11:00:00 14/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 14/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [11:00:00 14/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 14/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [11:00:00 14/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [11:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [11:00:00 14/01/2016] id: Stool Color/Consist el: 0 cu: CCU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [11:00:00 14/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 14/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [11:00:00 14/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [11:00:00 14/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [11:00:00 14/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [11:00:00 14/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [11:00:00 14/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [11:00:00 14/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd
t0: [10:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [10:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [10:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 90 vu: ml t0: [10:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 8 vu: ml t0: [10:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 7 vu: ml t0: [10:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [10:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [10:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip t0: [11:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [11:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
io: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ra: 10 ru: ml/hr
pt: TPN
id: Criticare HN el: 1 cu: CCU cg: RN io: Criticare HN Tube Feeding du: str rt: Gastric/Feeding Tube
t0: [09:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: cowker v1: 22 u1: BPM st: NotStopd t0: [12:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: cowker v1: MICU st: NotStopd t0: [12:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: cowker v1: Full Code st: NotStopd t0: [12:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: cowker v1: Yes st: NotStopd t0: [12:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: cowker v1: None st: NotStopd t0: [12:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: cowker v1: 56 u1: BPM st: NotStopd t0: [12:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: cowker v1: Sinus Brady st: NotStopd t0: [12:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: cowker v1: 97 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [12:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: cowker v1: 66 u1: mmHg st: NotStopd t0: [12:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: cowker v1: Universal st: NotStopd t0: [12:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: cowker v1: 28 u1: BPM st: NotStopd t0: [12:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: cowker v1: 99 u1: % st: NotStopd t0: [12:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: cowker v1: 1 u1: kg st: NotStopd t0: [12:00:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: cowker v1: 101 rs: Manual st: NotStopd
t0: [12:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: cowker ai: 107 vo: 20 vu: ml t0: [12:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: cowker ai: -1 vo: 90 vu: ml t0: [12:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: cowker ai: 209 vo: 8 vu: ml t0: [12:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: cowker ai: 416 vo: 7 vu: ml t0: [12:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: cowker ai: 431 vo: 4 vu: ml
t0: [12:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: cowker so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: cowker so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [12:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: cowker so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: cowker so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [12:00:00 14/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [12:00:00 14/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 14/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 14/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 14/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [12:00:00 14/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [12:00:00 14/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 7 u1: points st: NotStopd t0: [12:00:00 14/01/2016] id: GI Guaiac/ph el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [12:00:00 14/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 14/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [12:00:00 14/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [12:00:00 14/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 14/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 14/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 14/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 14/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [12:00:00 14/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Pain st: NotStopd t0: [12:00:00 14/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [12:00:00 14/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 14/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 14/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 14/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [12:00:00 14/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [12:00:00 14/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [12:00:00 14/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [12:00:00 14/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [12:00:00 14/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 14/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 14/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 14/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [12:30:00 14/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 0 vu: ml nb: 1
t0: [13:00:00 14/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [13:00:00 14/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [13:00:00 14/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [13:00:00 14/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [13:00:00 14/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [13:00:00 14/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:00:00 14/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [13:00:00 14/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [13:00:00 14/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [13:00:00 14/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [13:00:00 14/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [13:00:00 14/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [13:00:00 14/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [13:00:00 14/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [13:00:00 14/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:00:00 14/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [13:00:00 14/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [13:00:00 14/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [13:00:00 14/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [13:00:00 14/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [13:00:00 14/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [13:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 99 u1: % st: NotStopd t0: [13:00:00 14/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [13:00:00 14/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [13:00:00 14/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [13:00:00 14/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [13:00:00 14/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 306 u1: ml/B st: NotStopd t0: [13:00:00 14/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [13:00:00 14/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [13:00:00 14/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [13:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [13:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [13:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 52 u1: BPM st: NotStopd t0: [13:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [13:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 97 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [13:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [13:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [13:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [13:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [14:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 14/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [14:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 51 u1: BPM st: NotStopd t0: [14:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [14:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 95 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [14:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 66 u1: mmHg st: NotStopd t0: [14:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 29 u1: BPM st: NotStopd t0: [14:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 1000 vu: ml t0: [14:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [14:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 90 vu: ml t0: [14:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 8 vu: ml t0: [14:00:00 14/01/2016] tf: [03:00:00 15/01/2016] dt: 780 id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 15 vu: ml t0: [14:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 7 vu: ml t0: [14:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [13:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [13:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip t0: [14:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [14:30:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: cowker v1: 90 rs: Manual st: NotStopd
t0: [14:30:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [14:30:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:30:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:30:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:30:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 52 u1: BPM st: NotStopd t0: [14:30:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [14:30:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 100 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [14:30:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [14:30:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:30:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [14:30:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [14:30:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:30:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:30:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [14:30:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:30:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [16:00:00 14/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [16:00:00 14/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 14/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [16:00:00 14/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [16:00:00 14/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [16:00:00 14/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:00:00 14/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [16:00:00 14/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 14/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 14/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [16:00:00 14/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 14/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 14/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [16:00:00 14/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.2 u1: L/min st: NotStopd t0: [16:00:00 14/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 14/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 14/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [16:00:00 14/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [16:00:00 14/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [16:00:00 14/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [16:00:00 14/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [16:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 98 u1: % st: NotStopd t0: [16:00:00 14/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [16:00:00 14/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [16:00:00 14/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [16:00:00 14/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [16:00:00 14/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 270 u1: ml/B st: NotStopd t0: [16:00:00 14/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [16:00:00 14/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 14/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [16:08:00 14/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.32 rs: Final st: NotStopd t0: [16:08:00 14/01/2016] id: CaO2 el: 0 cu: CCU cg: 140 v1: 13.6045 u1: ml/dl st: NotStopd t0: [16:08:00 14/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 0 rs: Final st: NotStopd t0: [16:08:00 14/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 27 rs: Final st: NotStopd t0: [16:08:00 14/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 50 u1: mmHg rs: Final st: NotStopd t0: [16:08:00 14/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 152 u1: mmHg rs: Final st: NotStopd t0: [16:08:00 14/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.32 rs: Final st: NotStopd t0: [16:08:00 14/01/2016] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 99 u1: % rs: Final st: NotStopd t0: [16:11:00 14/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 113 rs: Final st: NotStopd t0: [16:11:00 14/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 113 rs: Final st: NotStopd
t0: [15:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [15:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [15:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 52 u1: BPM st: NotStopd t0: [15:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [15:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 85 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [15:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 60 u1: mmHg st: NotStopd t0: [15:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [15:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [15:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 14/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [16:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [16:00:00 14/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 14/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 14/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 14/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 14/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [16:00:00 14/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [16:00:00 14/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [16:00:00 14/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 7 u1: points st: NotStopd t0: [16:00:00 14/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [16:00:00 14/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 14/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 14/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 52 u1: BPM st: NotStopd t0: [16:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [16:00:00 14/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 14/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [16:00:00 14/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 14/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [16:00:00 14/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 14/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 14/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Pain st: NotStopd t0: [16:00:00 14/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [16:00:00 14/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 14/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 91 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [16:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [16:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [16:00:00 14/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 14/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [16:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 28 u1: BPM st: NotStopd t0: [16:00:00 14/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 14/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 14/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 14/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 14/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [16:00:00 14/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.5556 u1: Deg. C st: NotStopd t0: [16:00:00 14/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 96 u1: Deg. F st: NotStopd t0: [16:00:00 14/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 14/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 14/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 14/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [16:00:00 14/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [16:00:00 14/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [16:00:00 14/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 14/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 14/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [16:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [16:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 90 vu: ml t0: [16:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 3.5 vu: ml t0: [16:00:00 14/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [16:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 7 vu: ml t0: [16:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [15:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [15:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip t0: [16:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [16:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [17:00:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 135 rs: Manual st: NotStopd
t0: [17:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [17:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [17:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 49 u1: BPM st: NotStopd t0: [17:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [17:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 90 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [17:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 63 u1: mmHg st: NotStopd t0: [17:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [17:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [17:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:30:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [17:30:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:30:00 14/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [17:30:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [17:30:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:30:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 53 u1: BPM st: NotStopd t0: [17:30:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [17:30:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 96 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [17:30:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [17:30:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:30:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd t0: [17:30:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [17:30:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip t0: [17:30:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:30:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [17:30:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [17:30:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [17:00:00 14/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 30 vu: ml t0: [18:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [18:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 90 vu: ml t0: [18:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2.5 vu: ml t0: [18:00:00 14/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [18:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 7 vu: ml t0: [18:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [16:09:00 14/01/2016] id: Vancomycin/Random Drug Level el: 0 cu: CCU cg: 140 v1: 11.1 rs: Final st: NotStopd
t0: [20:00:00 14/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [20:00:00 14/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 14/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [20:00:00 14/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [20:00:00 14/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [20:00:00 14/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 14/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 14/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 14/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 14/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [20:00:00 14/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 14/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 14/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [20:00:00 14/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [20:00:00 14/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 14/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 14/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 14/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [20:00:00 14/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [20:00:00 14/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 14/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10.5 u1: cmH2O st: NotStopd t0: [20:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 99 u1: % st: NotStopd t0: [20:00:00 14/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [20:00:00 14/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [20:00:00 14/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [20:00:00 14/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [20:00:00 14/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 289 u1: ml/B st: NotStopd t0: [20:00:00 14/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [20:00:00 14/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 14/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 14/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 14/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [20:00:00 14/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [20:00:00 14/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 14/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 14/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 14/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 14/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 14/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 14/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [20:00:00 14/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 14/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Consistently st: NotStopd t0: [20:00:00 14/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 9 u1: points st: NotStopd t0: [20:00:00 14/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 14/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [20:00:00 14/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 14/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 14/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 14/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [20:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 49 u1: BPM st: NotStopd t0: [20:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 14/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [20:00:00 14/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 14/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 14/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Good st: NotStopd t0: [20:00:00 14/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 14/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [20:00:00 14/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 14/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 14/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 14/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [20:00:00 14/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 14/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 89 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [20:00:00 14/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [20:00:00 14/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [20:00:00 14/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:00:00 14/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 14/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 14/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [20:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [20:00:00 14/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 14/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 14/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 14/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 14/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [20:00:00 14/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.1111 u1: Deg. C st: NotStopd t0: [20:00:00 14/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 95.2 u1: Deg. F st: NotStopd t0: [20:00:00 14/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd t0: [20:00:00 14/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 14/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 14/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 180 rs: Manual st: NotStopd t0: [20:00:00 14/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [20:00:00 14/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [20:00:00 14/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 14/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 14/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [21:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [21:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 50 u1: BPM st: NotStopd t0: [21:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [21:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 95 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [21:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [21:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [21:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [21:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 14/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 30 vu: ml t0: [21:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 30 vu: ml t0: [21:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 135 vu: ml t0: [21:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 6 vu: ml t0: [21:00:00 14/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [21:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 10.5 vu: ml t0: [21:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 6 vu: ml
t0: [20:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [20:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [21:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [21:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 14/01/2016] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: RN cv: 110 ap: none
tf: [20:00:00 15/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 21 dn: 1 m1: Vancomycin HCl v1: 1000 u1: mg m2: Iso-Osmotic Dextrose v2: 200 u2: ml
t0: [22:00:00 14/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 183 rs: Manual st: NotStopd
t0: [22:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [22:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 52 u1: BPM st: NotStopd t0: [22:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [22:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 88 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [22:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 56 u1: mmHg st: NotStopd t0: [22:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [22:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [22:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [00:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWkr v1: 212 rs: Manual st: NotStopd
t0: [00:00:00 15/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [00:00:00 15/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 15/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [00:00:00 15/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 15/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 15/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 15/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 15/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 15/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 15/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 15/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.76 u1: L/min st: NotStopd t0: [00:00:00 15/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 15/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 15/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [00:00:00 15/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [00:00:00 15/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 15/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10.5 u1: cmH2O st: NotStopd t0: [00:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 98 u1: % st: NotStopd t0: [00:00:00 15/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [00:00:00 15/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [00:00:00 15/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [00:00:00 15/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 295 u1: ml/B st: NotStopd t0: [00:00:00 15/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [00:00:00 15/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 15/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 14/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 14/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v2: Negative st: NotStopd t0: [20:00:00 14/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [20:00:00 14/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [20:00:00 14/01/2016] id: ImpSkin Character #2 el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 14/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 14/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 14/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 14/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Crackles st: NotStopd t0: [20:00:00 14/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [20:00:00 14/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 14/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [20:00:00 14/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 14/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [20:00:00 14/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 14/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 14/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 14/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 14/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 14/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 14/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [20:00:00 14/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 14/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [20:00:00 14/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [23:00:00 14/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [23:00:00 14/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 14/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [23:00:00 14/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 14/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 14/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 59 u1: BPM st: NotStopd t0: [23:00:00 14/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [23:00:00 14/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 95 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [23:00:00 14/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [23:00:00 14/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [23:00:00 14/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [23:00:00 14/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 14/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [23:00:00 14/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.9444 u1: Deg. C st: NotStopd t0: [23:00:00 14/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 96.7 u1: Deg. F st: NotStopd t0: [23:00:00 14/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 15/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 15/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v2: Negative st: NotStopd t0: [00:00:00 15/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 15/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [00:00:00 15/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [00:00:00 15/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 15/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 15/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 15/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 15/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 15/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 15/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 15/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [00:00:00 15/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [00:00:00 15/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Consistently st: NotStopd t0: [00:00:00 15/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 7 u1: points st: NotStopd t0: [00:00:00 15/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [00:00:00 15/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 15/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 15/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 15/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 58 u1: BPM st: NotStopd t0: [00:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [00:00:00 15/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 15/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 15/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 15/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 15/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 15/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [00:00:00 15/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [00:00:00 15/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 15/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [00:00:00 15/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 15/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [00:00:00 15/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [00:00:00 15/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 15/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 15/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Good st: NotStopd t0: [00:00:00 15/01/2016] id: ImpSkin Character #2 el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 15/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 15/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 15/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 15/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 15/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [00:00:00 15/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 15/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 15/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Crackles st: NotStopd t0: [00:00:00 15/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [00:00:00 15/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Pain st: NotStopd t0: [00:00:00 15/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [00:00:00 15/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 15/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 15/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 92 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [00:00:00 15/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [00:00:00 15/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:00:00 15/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 15/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 15/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [00:00:00 15/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 15/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [00:00:00 15/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 15/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [00:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [00:00:00 15/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 15/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 15/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 15/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 15/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 15/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 15/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 15/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [00:00:00 15/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 15/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 15/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 15/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 15/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 15/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [00:00:00 15/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 15/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [00:00:00 15/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [00:00:00 15/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 15/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 15/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [00:00:00 15/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [00:00:00 15/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [22:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [22:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [22:00:00 14/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 10 vu: ml t0: [22:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [22:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml t0: [23:00:00 14/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 14/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [23:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 3 vu: ml t0: [23:00:00 14/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 10 vu: ml t0: [23:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [23:00:00 14/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml t0: [00:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [00:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [00:00:00 15/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 10 vu: ml t0: [00:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [00:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [23:00:00 14/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 14/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [23:00:00 14/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 14/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip t0: [00:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 15/01/2016] id: Levophed-k el: 1 cu: CCU cg: RN so: D5W vo: 0 v1: 0 du: mcgkgmin sv: 250 su: ml rt: IV Drip t0: [00:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 14/01/2016] dt: 24 id: Tube Feeds In Total el: 1 cu: CCU cg: RN pv: 10 cv: 105 ap: none
t0: [02:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWkr v1: 170 rs: Manual st: NotStopd
t0: [01:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [01:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [01:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 98 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [01:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 62 u1: mmHg st: NotStopd t0: [01:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [01:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [02:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [02:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [02:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 91 u1: mmHg v2: 43 u2: mmHg st: NotStopd t0: [02:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [02:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [02:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [02:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 15/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [02:00:00 15/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [02:00:00 15/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [02:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [01:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [01:00:00 15/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 10 vu: ml t0: [01:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [01:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml t0: [02:00:00 15/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 125 vu: ml t0: [02:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [02:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [02:00:00 15/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 10 vu: ml t0: [02:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [02:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [01:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip t0: [02:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 15/01/2016] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: RN cv: 70 ap: none
t0: [03:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [03:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [03:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [03:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 93 u1: mmHg v2: 43 u2: mmHg st: NotStopd t0: [03:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 59 u1: mmHg st: NotStopd t0: [03:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [03:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 6 u1: BPM st: NotStopd t0: [03:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [03:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [03:00:00 15/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 0 vu: ml t0: [03:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [03:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [03:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 15/01/2016] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN pv: 85 cv: 85 ap: none t0: [23:00:00 15/01/2016] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN pv: -22 cv: -22 ap: none t0: [23:00:00 15/01/2016] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN pv: 18 cv: 1453 ap: none t0: [23:00:00 15/01/2016] dt: 24 id: IV Nutrition Total el: 1 cu: CCU cg: RN pv: 45 cv: 1093.6 ap: none t0: [23:00:00 15/01/2016] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN pv: 63 cv: 2646.6 ap: none t0: [23:00:00 15/01/2016] dt: 24 id: Tube Feeds In Total el: 1 cu: CCU cg: 140 cv: 30 ap: none t0: [23:00:00 15/01/2016] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN pv: 85 cv: 832 ap: none t0: [23:00:00 15/01/2016] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN pv: -22 cv: 1814.6 ap: none t0: [23:00:00 15/01/2016] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN pv: 85 cv: 832 ap: none t0: [23:00:00 15/01/2016] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN pv: -22 cv: 14238 ap: carryForward
t0: [04:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWkr v1: 160 rs: Manual st: NotStopd
t0: [00:00:00 15/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 15/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 15/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [01:00:00 15/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [01:00:00 15/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [01:00:00 15/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [04:00:00 15/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 15/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v2: Negative st: NotStopd t0: [04:00:00 15/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 15/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [04:00:00 15/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 15/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 15/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 15/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 15/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [04:00:00 15/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [04:00:00 15/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Consistently st: NotStopd t0: [04:00:00 15/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 7 u1: points st: NotStopd t0: [04:00:00 15/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [04:00:00 15/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 15/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 15/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [04:00:00 15/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 73 u1: BPM st: NotStopd t0: [04:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 15/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 15/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 15/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 15/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 15/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 15/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [04:00:00 15/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [04:00:00 15/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 15/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [04:00:00 15/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 15/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [04:00:00 15/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [04:00:00 15/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 15/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 15/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Good st: NotStopd t0: [04:00:00 15/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 15/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [04:00:00 15/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 15/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 15/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Crackles st: NotStopd t0: [04:00:00 15/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [04:00:00 15/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Pain st: NotStopd t0: [04:00:00 15/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [04:00:00 15/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 15/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 15/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 114 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [04:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [04:00:00 15/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 15/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:00:00 15/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [04:00:00 15/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [04:00:00 15/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [04:00:00 15/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 15/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [04:00:00 15/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 15/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [04:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [04:00:00 15/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 15/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 15/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [04:00:00 15/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 15/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 15/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 15/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 15/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [04:00:00 15/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [04:00:00 15/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [04:00:00 15/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 15/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 15/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [04:00:00 15/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [04:00:00 15/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd
t0: [04:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [04:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [04:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [04:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [04:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [04:00:00 15/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [04:00:00 15/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 15/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 15/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RN v1: 25cm v2: Lip st: NotStopd t0: [04:00:00 15/01/2016] id: Airway Size el: 0 cu: CCU cg: RN v1: 7.5 mm st: NotStopd t0: [04:00:00 15/01/2016] id: Airway Type el: 0 cu: CCU cg: RN v1: Endotracheal st: NotStopd t0: [04:00:00 15/01/2016] id: Intubation Date el: 0 cu: CCU cg: RN v1: 12 v2: 23 st: NotStopd t0: [04:00:00 15/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 15/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RN v1: Drager st: NotStopd t0: [04:00:00 15/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 15/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 15/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 15/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 15/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 15/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [04:00:00 15/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [05:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [05:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [05:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 109 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [05:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [05:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [05:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [06:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [06:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [06:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 109 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [06:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [06:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [06:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [06:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [06:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 143 rs: Manual st: NotStopd
t0: [05:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [05:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [05:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [05:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml t0: [06:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [06:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [06:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [06:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [05:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip t0: [06:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [06:00:00 15/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [06:00:00 15/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [06:00:00 15/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 99.4 u1: Deg. F st: NotStopd
t0: [05:57:00 15/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.26 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: -2 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 26 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 55 u1: mmHg rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 135 u1: mmHg rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.26 rs: Final st: NotStopd
t0: [06:00:00 15/01/2016] id: RSBI Not Completed el: 0 cu: CCU cg: RRT v1: Other/Remarks st: NotStopd t0: [06:00:00 15/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [06:00:00 15/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [06:00:00 15/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [06:00:00 15/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [06:00:00 15/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [06:00:00 15/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [06:00:00 15/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [06:00:00 15/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [06:00:00 15/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [06:00:00 15/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [06:00:00 15/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [06:00:00 15/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [06:00:00 15/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [06:00:00 15/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [06:00:00 15/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [06:00:00 15/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [06:00:00 15/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [06:00:00 15/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [06:00:00 15/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [06:00:00 15/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [06:00:00 15/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10.5 u1: cmH2O st: NotStopd t0: [06:00:00 15/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [06:00:00 15/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [06:00:00 15/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [06:00:00 15/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 287 u1: ml/B st: NotStopd t0: [06:00:00 15/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [06:00:00 15/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [06:00:00 15/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 15/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vu: ml t0: [05:00:00 15/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vu: ml t0: [06:00:00 15/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vu: ml
t0: [05:57:00 15/01/2016] id: PT el: 0 cu: CCU cg: 140 v1: 13.1 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: INR Coags el: 0 cu: CCU cg: 140 v1: 1.1 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: PTT Coags el: 0 cu: CCU cg: 140 v1: 33.3 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CCU cg: 140 v1: 1.1 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: PT(11-13.5) Coags el: 0 cu: CCU cg: 140 v1: 13.1 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: PTT(22-35) Coags el: 0 cu: CCU cg: 140 v1: 33.3 rs: Final st: NotStopd
t0: [05:57:00 15/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 12.4 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 12.4 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 30.2 u1: % rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 9.3 u1: gm/dl rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 271 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 3.13 u1: /mic l rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 12.4 rs: Final st: NotStopd
t0: [05:57:00 15/01/2016] id: BUN el: 0 cu: CCU cg: 140 v1: 73 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Albumin Chemistry el: 0 cu: CCU cg: 140 v1: 2.7 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 8.6 u1: mg/dl rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 110 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 2.8 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 130 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 2.5 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 5.8 u1: mEq/L rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 4.3 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 143 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Total Bili Chemistry el: 0 cu: CCU cg: 140 v1: 0.9 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: ALT Enzymes el: 0 cu: CCU cg: 140 v1: 4 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: AST Enzymes el: 0 cu: CCU cg: 140 v1: 9 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Albumin (>3.2) Chemistry el: 0 cu: CCU cg: 140 v1: 2.7 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Alk. Phosphate Enzymes el: 0 cu: CCU cg: 140 v1: 63 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 73 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 8.6 u1: mg/dl rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 25 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 110 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 2.8 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 130 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: LDH Enzymes el: 0 cu: CCU cg: 140 v1: 123 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 2.5 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 5.8 u1: mEq/L rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 4.3 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 143 rs: Final st: NotStopd t0: [05:57:00 15/01/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: CCU cg: 140 v1: 0.9 rs: Final st: NotStopd
t0: [07:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [07:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [07:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [07:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 108 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [07:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [07:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [07:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [07:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [05:57:00 15/01/2016] id: Amylase Enzymes el: 0 cu: CCU cg: 140 v1: 24 rs: Final st: NotStopd
t0: [08:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: cowker v1: 125 rs: Manual st: NotStopd
t0: [08:00:00 15/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [08:00:00 15/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 15/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [08:00:00 15/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 15/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [08:00:00 15/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 15/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 15/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 15/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 15/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [08:00:00 15/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [08:00:00 15/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.1 u1: L/min st: NotStopd t0: [08:00:00 15/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 15/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 15/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [08:00:00 15/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 15/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [08:00:00 15/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 15/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10.5 u1: cmH2O st: NotStopd t0: [08:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 98 u1: % st: NotStopd t0: [08:00:00 15/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [08:00:00 15/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [08:00:00 15/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [08:00:00 15/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 293 u1: ml/B st: NotStopd t0: [08:00:00 15/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [08:00:00 15/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 15/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 15/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 15/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 15/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 15/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 15/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Grimace Scale st: NotStopd t0: [08:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [08:00:00 15/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 15/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 15/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 15/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: No/O2 Issues st: NotStopd t0: [08:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 15/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 15/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 15/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [08:00:00 15/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [08:00:00 15/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [08:00:00 15/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 7 u1: points st: NotStopd t0: [08:00:00 15/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 15/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 15/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 15/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [08:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 15/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [08:00:00 15/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 15/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 15/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 15/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 15/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 15/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [08:00:00 15/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 15/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [08:00:00 15/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 15/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [08:00:00 15/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 15/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 15/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 15/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 15/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Pain st: NotStopd t0: [08:00:00 15/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [08:00:00 15/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 15/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 111 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [08:00:00 15/01/2016] id: Pain Management el: 1 cu: CCU cg: RN v1: IV Gtt v2: IV Gtt st: NotStopd t0: [08:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [08:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:00:00 15/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [08:00:00 15/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [08:00:00 15/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 15/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 15/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 15/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [08:00:00 15/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 15/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 15/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 15/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 15/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 15/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 15/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 15/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [08:00:00 15/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [08:00:00 15/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 15/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 15/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 15/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 15/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [08:00:00 15/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [08:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 90 vu: ml t0: [08:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 8 vu: ml t0: [08:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 7 vu: ml t0: [08:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [08:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [07:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN u1: BPM st: NotStopd t0: [08:00:00 15/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [08:00:00 15/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 15/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 15/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 15/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [08:00:00 15/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 15/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 35 u1: BPM st: NotStopd t0: [08:00:00 15/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd t0: [09:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [09:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 15/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [09:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 75 u1: BPM st: NotStopd t0: [09:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 15/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 15/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 15/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 122 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [09:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [09:00:00 15/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [09:00:00 15/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:00:00 15/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [09:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [09:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 15/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [09:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [09:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [09:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [09:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [09:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [10:00:00 15/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [10:00:00 15/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [10:00:00 15/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [10:00:00 15/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [10:00:00 15/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [10:00:00 15/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [10:00:00 15/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [10:00:00 15/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [10:00:00 15/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [10:00:00 15/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [10:00:00 15/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [10:00:00 15/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [10:00:00 15/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [10:00:00 15/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [10:00:00 15/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [10:00:00 15/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [10:00:00 15/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [10:00:00 15/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [10:00:00 15/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [10:00:00 15/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [10:00:00 15/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10.5 u1: cmH2O st: NotStopd t0: [10:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 97 u1: % st: NotStopd t0: [10:00:00 15/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [10:00:00 15/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [10:00:00 15/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [10:00:00 15/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 306 u1: ml/B st: NotStopd t0: [10:00:00 15/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [10:00:00 15/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [10:00:00 15/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [10:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [10:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [10:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 108 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [10:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [10:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 38 u1: BPM st: NotStopd t0: [10:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [10:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [10:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [10:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [10:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [09:00:00 15/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [09:00:00 15/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 38.1111 u1: Deg. C st: NotStopd t0: [09:00:00 15/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 100.6 u1: Deg. F st: NotStopd t0: [10:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 115 rs: Manual st: NotStopd
t0: [11:06:00 15/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.32 rs: Final st: NotStopd t0: [11:06:00 15/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: -1 rs: Final st: NotStopd t0: [11:06:00 15/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 26 rs: Final st: NotStopd t0: [11:06:00 15/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 48 u1: mmHg rs: Final st: NotStopd t0: [11:06:00 15/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 130 u1: mmHg rs: Final st: NotStopd t0: [11:06:00 15/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.32 rs: Final st: NotStopd
t0: [08:00:00 15/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 15/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: CCU cg: RN v1: Wound Cleanser st: NotStopd t0: [08:00:00 15/01/2016] id: ImpSkin Character #1 el: 0 cu: CCU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 15/01/2016] id: ImpSkin Character #2 el: 0 cu: CCU cg: RN v1: Blister st: NotStopd t0: [08:00:00 15/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 15/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CCU cg: RN v1: Serous v2: Small st: NotStopd t0: [08:00:00 15/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 15/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Alginate/Kalstat st: NotStopd t0: [08:00:00 15/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CCU cg: RN v1: Pink st: NotStopd t0: [08:00:00 15/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [08:00:00 15/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CCU cg: RN v1: Approximated st: NotStopd t0: [08:00:00 15/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 15/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 15/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 15/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 15/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [11:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [11:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 15/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 15/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [11:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [11:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 15/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 15/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 15/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 15/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 114 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [11:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [11:00:00 15/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 15/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [11:00:00 15/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [11:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 46 u1: BPM st: NotStopd t0: [11:00:00 15/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [11:00:00 15/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 15/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 15/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [12:00:00 15/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 15/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 15/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 15/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 15/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [12:00:00 15/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 7 u1: points st: NotStopd t0: [12:00:00 15/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [12:00:00 15/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 15/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 15/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [12:00:00 15/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [12:00:00 15/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: RN v1: WNL st: NotStopd t0: [12:00:00 15/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Pain st: NotStopd t0: [12:00:00 15/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [12:00:00 15/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 117 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [12:00:00 15/01/2016] id: Pain Management el: 1 cu: CCU cg: RN v1: IV Gtt v2: IV Gtt st: NotStopd t0: [12:00:00 15/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [12:00:00 15/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 15/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 15/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [11:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [11:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [11:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [11:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml t0: [12:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [12:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [12:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [12:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [11:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [12:00:00 15/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [12:00:00 15/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 15/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [12:00:00 15/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [12:00:00 15/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3.3 st: NotStopd t0: [12:00:00 15/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 15/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 15/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 15/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 15/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [12:00:00 15/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:00:00 15/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 13.3 u1: L/min st: NotStopd t0: [12:00:00 15/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 15/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 15/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [12:00:00 15/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [12:00:00 15/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 46 u1: BPM st: NotStopd t0: [12:00:00 15/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [12:00:00 15/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10.5 u1: cmH2O st: NotStopd t0: [12:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 97 u1: % st: NotStopd t0: [12:00:00 15/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [12:00:00 15/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [12:00:00 15/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [12:00:00 15/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:00:00 15/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [12:00:00 15/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 15/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [12:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [12:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [12:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [12:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [12:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [12:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 45 u1: BPM st: NotStopd t0: [12:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 121 rs: Manual st: NotStopd t0: [13:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [13:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [13:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 64 u1: BPM st: NotStopd t0: [13:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 116 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [13:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [13:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [13:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 47 u1: BPM st: NotStopd t0: [13:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [13:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip t0: [13:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
pt: TPN
t0: [13:00:00 15/01/2016] id: Less Restrict Meas. el: 0 cu: CCU cg: RN v1: Medicated st: NotStopd t0: [13:00:00 15/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [13:00:00 15/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [13:00:00 15/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [13:00:00 15/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 15/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 15/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [13:00:00 15/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [13:00:00 15/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [13:00:00 15/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [13:00:00 15/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 15/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [13:00:00 15/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:00:00 15/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [13:00:00 15/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [13:00:00 15/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [13:00:00 15/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [13:00:00 15/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [13:00:00 15/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [14:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 63 u1: BPM st: NotStopd t0: [14:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 118 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [14:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [14:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [14:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [14:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 90 vu: ml t0: [14:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 8 vu: ml t0: [14:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5.5 vu: ml t0: [14:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [14:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [14:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: cowker v1: 118 rs: Manual st: NotStopd
t0: [14:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 38 u1: BPM st: NotStopd t0: [15:00:00 15/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [15:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [15:00:00 15/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [15:00:00 15/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [15:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [15:00:00 15/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: Tube Feeding st: NotStopd t0: [15:00:00 15/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RN v1: 25cm v2: Lip st: NotStopd t0: [15:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 15/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [15:00:00 15/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [15:00:00 15/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [15:00:00 15/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [15:00:00 15/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [15:00:00 15/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [15:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 62 u1: BPM st: NotStopd t0: [15:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 15/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 15/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 15/01/2016] id: Airway Size el: 0 cu: CCU cg: RN v1: 7.5 mm st: NotStopd t0: [15:00:00 15/01/2016] id: Airway Type el: 0 cu: CCU cg: RN v1: Endotracheal st: NotStopd t0: [15:00:00 15/01/2016] id: Intubation Date el: 0 cu: CCU cg: RN v1: 12 v2: 23 st: NotStopd t0: [15:00:00 15/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [15:00:00 15/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [15:00:00 15/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [15:00:00 15/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 118 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [15:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [15:00:00 15/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [15:00:00 15/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [15:00:00 15/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [15:00:00 15/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [15:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 43 u1: BPM st: NotStopd t0: [15:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [15:00:00 15/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [15:00:00 15/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [15:00:00 15/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RN v1: Drager st: NotStopd t0: [15:00:00 15/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [15:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 15/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd
t0: [15:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [15:00:00 15/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [15:00:00 15/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [15:00:00 15/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 99.8 u1: Deg. F st: NotStopd
t0: [13:00:00 15/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [15:00:00 15/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [15:00:00 15/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [15:00:00 15/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Consistently st: NotStopd t0: [15:00:00 15/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [15:00:00 15/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 15/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 15/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [15:00:00 15/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [15:00:00 15/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [15:00:00 15/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [15:00:00 15/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [15:00:00 15/01/2016] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: White v2: Thick st: NotStopd t0: [15:00:00 15/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [15:00:00 15/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [15:00:00 15/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [15:00:00 15/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [15:00:00 15/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [15:00:00 15/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [15:00:00 15/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [16:00:00 15/01/2016] id: Less Restrict Meas. el: 0 cu: CCU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 15/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [16:00:00 15/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [16:00:00 15/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Non-verbal cues st: NotStopd t0: [16:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [16:00:00 15/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 15/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 15/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 15/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 15/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [16:00:00 15/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [16:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 64 u1: BPM st: NotStopd t0: [16:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 15/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 15/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [16:00:00 15/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 15/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 15/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [16:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 117 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [16:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [16:00:00 15/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [16:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [16:00:00 15/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [16:00:00 15/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 15/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [16:00:00 15/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 15/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 15/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 15/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [16:00:00 15/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [16:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 90 vu: ml t0: [16:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 8 vu: ml t0: [16:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [16:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [16:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
tf: [10:00:00 17/01/2016] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Aluminum Hydroxide Suspension v1: 30 u1: ml
t0: [16:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 111 rs: Manual st: NotStopd
t0: [16:00:00 15/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [16:00:00 15/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 15/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [16:00:00 15/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [16:00:00 15/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3.3 st: NotStopd t0: [16:00:00 15/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:00:00 15/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [16:00:00 15/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 15/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 15/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [16:00:00 15/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 15/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 15/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [16:00:00 15/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 12.4 u1: L/min st: NotStopd t0: [16:00:00 15/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 15/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 15/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [16:00:00 15/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [16:00:00 15/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 41 u1: BPM st: NotStopd t0: [16:00:00 15/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [16:00:00 15/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [16:00:00 15/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [16:00:00 15/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [16:00:00 15/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [16:00:00 15/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 316 u1: ml/B st: NotStopd t0: [16:00:00 15/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [16:00:00 15/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 15/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
tf: [17:00:00 16/01/2016] pt: IV Piggyback rt: IV fr: Q24H fs: 17 dn: 1 m1: Ceftazidime v1: 1 u1: gm m2: Iso-Osmotic Dextrose v2: 50 u2: ml
t0: [16:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 47 u1: BPM st: NotStopd t0: [17:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [17:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [17:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 15/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 15 degrees st: NotStopd t0: [17:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 64 u1: BPM st: NotStopd t0: [17:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 15/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 15/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [17:00:00 15/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 118 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [17:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [17:00:00 15/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [17:00:00 15/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 38 u1: BPM st: NotStopd t0: [17:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [17:00:00 15/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [17:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [17:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [17:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2 vu: ml t0: [17:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [17:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
tf: [15:00:00 15/01/2016] pt: Unit Dose rt: IV fr: QID fs: 10, 14, 18, 22 dn: 4 m1: Metoclopramide v1: 10 u1: mg tf: [16:00:00 15/01/2016] pt: Unit Dose rt: IV fr: QID fs: 10, 14, 18, 22 dn: 4 m1: Metoclopramide v1: 10 u1: mg tf: [10:00:00 21/01/2016] pt: Unit Dose rt: IV fr: QID fs: 10, 14, 18, 22 dn: 4 m1: Metoclopramide v1: 5 u1: mg tf: [15:00:00 03/02/2016] pt: Unit Dose rt: PO fr: QID fs: 10, 14, 18, 22 dn: 4 m1: Metoclopramide v1: 10 u1: mg tf: [15:00:00 03/02/2016] pt: Unit Dose rt: PO fr: QID fs: 10, 14, 18, 22 dn: 4 m1: Metoclopramide v1: 10 u1: mg tf: [15:00:00 03/02/2016] pt: Unit Dose rt: PO fr: QID fs: 10, 14, 18, 22 dn: 4 m1: Metoclopramide v1: 5 u1: mg
t0: [17:00:00 15/01/2016] id: NBP el: 0 cu: CCU cg: RN u1: mmHg u2: mmHg st: NotStopd t0: [18:00:00 15/01/2016] id: Less Restrict Meas. el: 0 cu: CCU cg: RN v1: Medicated st: NotStopd t0: [18:00:00 15/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [18:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: CCU st: NotStopd t0: [18:00:00 15/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [18:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 15/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [18:00:00 15/01/2016] id: Education Topic #1 el: 0 cu: CCU cg: RN v1: ICU Environment st: NotStopd t0: [18:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 60 u1: BPM st: NotStopd t0: [18:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 15/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [18:00:00 15/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [18:00:00 15/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [18:00:00 15/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [18:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 106 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [18:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [18:00:00 15/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [18:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:00:00 15/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 15/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [18:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 38 u1: BPM st: NotStopd t0: [18:00:00 15/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 15/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 15/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 15/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 15/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 104 rs: Manual st: NotStopd
t0: [08:00:00 15/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 100 vu: ml t0: [12:00:00 15/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 90 vu: ml t0: [16:00:00 15/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 80 vu: ml t0: [18:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.6 vu: ml t0: [18:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [18:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2 vu: ml t0: [18:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [18:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [19:00:00 15/01/2016] id: INV#3Chg o/Wire Date el: 0 cu: CCU cg: -1 st: D/C'd t0: [19:00:00 15/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: CCU cg: -1 st: D/C'd t0: [19:00:00 15/01/2016] id: INV Line#1SiteAppear el: 0 cu: CCU cg: -1 st: D/C'd t0: [19:00:00 15/01/2016] id: INV Line#2 Zero/Cal el: 0 cu: CCU cg: -1 st: D/C'd t0: [19:00:00 15/01/2016] id: INV Line#2SiteAppear el: 0 cu: CCU cg: -1 st: D/C'd t0: [19:00:00 15/01/2016] id: INV Line#3 Site Date el: 0 cu: CCU cg: -1 st: D/C'd t0: [19:00:00 15/01/2016] id: INV Line#3SiteAppear el: 0 cu: CCU cg: -1 st: D/C'd t0: [19:00:00 15/01/2016] id: INV#1 WaveformAppear el: 0 cu: CCU cg: -1 st: D/C'd t0: [19:00:00 15/01/2016] id: INV#2 WaveformAppear el: 0 cu: CCU cg: -1 st: D/C'd t0: [19:00:00 15/01/2016] id: NBP el: 0 cu: CCU cg: -1 st: D/C'd t0: [19:00:00 15/01/2016] id: NBP Mean el: 0 cu: CCU cg: -1 st: D/C'd
t0: [20:00:00 15/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: -1 ai: 128 vo: 0 st: D/C'd
t0: [20:00:00 15/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 15/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [20:00:00 15/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 15/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [20:00:00 15/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 15/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 15/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 15/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 15/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [20:00:00 15/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 15/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 15/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [20:00:00 15/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 9 u1: points st: NotStopd t0: [20:00:00 15/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [20:00:00 15/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [20:00:00 15/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 15/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 15/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 15/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 15/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 15/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 15/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [20:00:00 15/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [20:00:00 15/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [20:00:00 15/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 15/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 15/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 15/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [20:00:00 15/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 15/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 15/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 15/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 15/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 15/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 15/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 15/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 15/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [20:00:00 15/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 15/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [20:00:00 15/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 15/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 15/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 15/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [20:00:00 15/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [20:00:00 15/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [20:00:00 15/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 15/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 15/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 15/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 15/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 15/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 15/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 15/01/2016] id: Behavior el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 15/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 15/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [20:00:00 15/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 15/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 15/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [20:00:00 15/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 15/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [20:00:00 15/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serous st: NotStopd t0: [20:30:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [20:30:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:30:00 15/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [20:30:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:30:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:30:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:30:00 15/01/2016] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [20:30:00 15/01/2016] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:30:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 61 u1: BPM st: NotStopd t0: [20:30:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [20:30:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 111 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [20:30:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [20:30:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:30:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [20:30:00 15/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [20:30:00 15/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [20:30:00 15/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [20:30:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:30:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 25 vu: ml t0: [20:30:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 112.5 vu: ml t0: [20:30:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 10 vu: ml t0: [20:30:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 5 vu: ml t0: [20:30:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 5 vu: ml
t0: [20:30:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:30:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:30:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [20:49:00 15/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.36 rs: Final st: NotStopd t0: [20:49:00 15/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: -1 rs: Final st: NotStopd t0: [20:49:00 15/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 25 rs: Final st: NotStopd t0: [20:49:00 15/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 42 u1: mmHg rs: Final st: NotStopd t0: [20:49:00 15/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 161 u1: mmHg rs: Final st: NotStopd t0: [20:49:00 15/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.36 rs: Final st: NotStopd
t0: [21:00:00 15/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [21:00:00 15/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [21:00:00 15/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [21:00:00 15/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [21:00:00 15/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3.0 st: NotStopd t0: [21:00:00 15/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [21:00:00 15/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [21:00:00 15/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [21:00:00 15/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [21:00:00 15/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [21:00:00 15/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [21:00:00 15/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [21:00:00 15/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [21:00:00 15/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [21:00:00 15/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [21:00:00 15/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [21:00:00 15/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [21:00:00 15/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [21:00:00 15/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [21:00:00 15/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [21:00:00 15/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [21:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 98 u1: % st: NotStopd t0: [21:00:00 15/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [21:00:00 15/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3.0 st: NotStopd t0: [21:00:00 15/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [21:00:00 15/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [21:00:00 15/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [21:00:00 15/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 303 u1: ml/B st: NotStopd t0: [21:00:00 15/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [21:00:00 15/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [21:00:00 15/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [22:02:00 15/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.29 rs: Final st: NotStopd t0: [22:02:00 15/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 0 rs: Final st: NotStopd t0: [22:02:00 15/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 29 rs: Final st: NotStopd t0: [22:02:00 15/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 57 u1: mmHg rs: Final st: NotStopd t0: [22:02:00 15/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 163 u1: mmHg rs: Final st: NotStopd t0: [22:02:00 15/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.29 rs: Final st: NotStopd
t0: [20:30:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 34 u1: BPM st: NotStopd t0: [22:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [22:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 62 u1: BPM st: NotStopd t0: [22:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 115 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [22:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [22:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [22:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [22:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 15/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [23:00:00 15/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 15/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [23:00:00 15/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 15/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 15/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 61 u1: BPM st: NotStopd t0: [23:00:00 15/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 15/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 118 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [23:00:00 15/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [23:00:00 15/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [23:00:00 15/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [23:00:00 15/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 15/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [23:00:00 15/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [23:00:00 15/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [23:00:00 15/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 15 vu: ml t0: [22:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 67.5 vu: ml t0: [22:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 6 vu: ml t0: [22:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [22:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml t0: [23:00:00 15/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 15/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 45 vu: ml t0: [23:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [23:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2 vu: ml t0: [23:00:00 15/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [22:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip t0: [23:00:00 15/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 15/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 15/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [01:00:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [01:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 59 u1: BPM st: NotStopd t0: [01:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [01:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 127 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [01:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [01:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [01:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [01:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 90 vu: ml t0: [01:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 8 vu: ml t0: [01:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [01:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [01:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 16/01/2016] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN pv: 65 cv: 65 ap: none t0: [23:00:00 16/01/2016] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN pv: 18.8 cv: 18.8 ap: none t0: [23:00:00 16/01/2016] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN pv: 15.5 cv: 642.5 ap: none t0: [23:00:00 16/01/2016] dt: 24 id: IV Nutrition Total el: 1 cu: CCU cg: RN pv: 58.3 cv: 1324.5 ap: none t0: [23:00:00 16/01/2016] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN pv: 83.8 cv: 2297 ap: none t0: [23:00:00 16/01/2016] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN pv: 65 cv: 1470 ap: none t0: [23:00:00 16/01/2016] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN pv: 18.8 cv: 777 ap: none t0: [23:00:00 16/01/2016] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN pv: 65 cv: 1520 ap: none t0: [23:00:00 16/01/2016] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN pv: 18.8 cv: 15015 ap: carryForward
t0: [01:00:00 16/01/2016] id: Peak Flow el: 0 cu: CCU cg: -1 st: D/C'd t0: [01:00:00 16/01/2016] id: Pressure Support el: 0 cu: CCU cg: -1 st: D/C'd t0: [01:00:00 16/01/2016] id: Tidal Volume (Set) el: 0 cu: CCU cg: -1 st: D/C'd t0: [01:00:00 16/01/2016] id: Tidal Volume (Spont) el: 0 cu: CCU cg: -1 st: D/C'd
t0: [01:00:00 16/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [01:00:00 16/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [01:00:00 16/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [01:00:00 16/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [01:00:00 16/01/2016] id: I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [01:00:00 16/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [01:00:00 16/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [01:00:00 16/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:00:00 16/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 16/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [01:00:00 16/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [01:00:00 16/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [01:00:00 16/01/2016] id: Mean Airway Pressure el: 0 cu: CCU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [01:00:00 16/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.2 u1: L/min st: NotStopd t0: [01:00:00 16/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 16/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 16/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [01:00:00 16/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [01:00:00 16/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [01:00:00 16/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [01:00:00 16/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [01:00:00 16/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [01:00:00 16/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3.0 st: NotStopd t0: [01:00:00 16/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [01:00:00 16/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [01:00:00 16/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [01:00:00 16/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 283 u1: ml/B st: NotStopd t0: [01:00:00 16/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [01:00:00 16/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [01:00:00 16/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 112 rs: Manual st: NotStopd t0: [23:00:00 15/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 106 rs: Manual st: NotStopd t0: [02:00:00 16/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 110 rs: Manual st: NotStopd t0: [03:00:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [03:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [03:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 67 u1: BPM st: NotStopd t0: [03:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 133 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [03:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [03:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [03:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [03:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [03:00:00 16/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [03:00:00 16/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [03:00:00 16/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [03:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [03:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 90 vu: ml t0: [03:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 8 vu: ml t0: [03:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [03:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [03:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [04:16:00 16/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.26 rs: Final st: NotStopd t0: [04:16:00 16/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: -1 rs: Final st: NotStopd t0: [04:16:00 16/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 28 rs: Final st: NotStopd t0: [04:16:00 16/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 59 u1: mmHg rs: Final st: NotStopd t0: [04:16:00 16/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 162 u1: mmHg rs: Final st: NotStopd t0: [04:16:00 16/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.26 rs: Final st: NotStopd
t0: [05:00:00 16/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 16/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [05:00:00 16/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [05:00:00 16/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 16/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [05:00:00 16/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [05:00:00 16/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [05:00:00 16/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [05:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 16/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [05:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 16/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [05:00:00 16/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [05:00:00 16/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [05:00:00 16/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 8 u1: points st: NotStopd t0: [05:00:00 16/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [05:00:00 16/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [05:00:00 16/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [05:00:00 16/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [05:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 66 u1: BPM st: NotStopd t0: [05:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 16/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [05:00:00 16/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 16/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 16/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [05:00:00 16/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [05:00:00 16/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [05:00:00 16/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 16/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm Distended st: NotStopd t0: [05:00:00 16/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [05:00:00 16/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [05:00:00 16/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [05:00:00 16/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [05:00:00 16/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 16/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 16/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 16/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [05:00:00 16/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [05:00:00 16/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 145 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [05:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [05:00:00 16/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:00:00 16/01/2016] id: Pupil Response R/L el: 0 cu: CCU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [05:00:00 16/01/2016] id: Pupil Size R/L el: 0 cu: CCU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [05:00:00 16/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 16/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 16/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [05:00:00 16/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 16/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [05:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd t0: [05:00:00 16/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [05:00:00 16/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [05:00:00 16/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [05:00:00 16/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [05:00:00 16/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [05:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 95 u1: % st: NotStopd t0: [05:00:00 16/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [05:00:00 16/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 16/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [05:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 16/01/2016] id: Behavior el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 16/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [05:00:00 16/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [05:00:00 16/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [05:00:00 16/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 16/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [05:00:00 16/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [05:00:00 16/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [05:00:00 16/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [05:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [05:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 90 vu: ml t0: [05:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 8 vu: ml t0: [05:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [05:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [05:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [05:00:00 16/01/2016] id: RSBI Not Completed el: 0 cu: CCU cg: RRT v1: Other/Remarks st: NotStopd t0: [05:00:00 16/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [05:00:00 16/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [05:00:00 16/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [05:00:00 16/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [05:00:00 16/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:00:00 16/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [05:00:00 16/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:00:00 16/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 16/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [05:00:00 16/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:00:00 16/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:00:00 16/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.2 u1: L/min st: NotStopd t0: [05:00:00 16/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 16/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 16/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [05:00:00 16/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [05:00:00 16/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [05:00:00 16/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [05:00:00 16/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [05:00:00 16/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [05:00:00 16/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [05:00:00 16/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [05:00:00 16/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [05:00:00 16/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [05:00:00 16/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 285 u1: ml/B st: NotStopd t0: [05:00:00 16/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [05:00:00 16/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [05:00:00 16/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [03:58:00 16/01/2016] id: BUN el: 0 cu: CCU cg: 140 v1: 85 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 110 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 2.6 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 77 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 2.4 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 4.7 u1: mEq/L rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 3.8 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 144 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 85 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 26 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 110 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 2.6 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 77 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 2.4 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 4.7 u1: mEq/L rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 3.8 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 144 rs: Final st: NotStopd
t0: [03:58:00 16/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 12.5 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 12.5 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 30.9 u1: % rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 9.2 u1: gm/dl rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 300 rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 3.15 u1: /mic l rs: Final st: NotStopd t0: [03:58:00 16/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 12.5 rs: Final st: NotStopd
t0: [06:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [08:00:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [08:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 57 u1: BPM st: NotStopd t0: [08:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [08:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 122 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [08:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [08:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [08:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 96 u1: % st: NotStopd t0: [08:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 30 vu: ml t0: [08:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 180 vu: ml t0: [08:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 8 vu: ml t0: [08:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 6 vu: ml t0: [08:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 6 vu: ml
t0: [08:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [08:00:00 16/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 16/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36 u1: Deg. C st: NotStopd t0: [08:00:00 16/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 96.8 u1: Deg. F st: NotStopd
t0: [08:00:00 16/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 81 rs: Manual st: NotStopd
t0: [08:00:00 16/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [08:00:00 16/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 16/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [08:00:00 16/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 16/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 16/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 16/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 16/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 16/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [08:00:00 16/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 16/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 16/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.75 u1: L/min st: NotStopd t0: [08:00:00 16/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 16/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 16/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [08:00:00 16/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [08:00:00 16/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 16/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 16/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [08:00:00 16/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [08:00:00 16/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [08:00:00 16/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [08:00:00 16/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [08:00:00 16/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [08:00:00 16/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 303 u1: ml/B st: NotStopd t0: [08:00:00 16/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [08:00:00 16/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 16/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 16/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 16/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 16/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 16/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 16/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 16/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 16/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [08:00:00 16/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 16/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 16/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Left Nare st: NotStopd t0: [08:00:00 16/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 16/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [08:00:00 16/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 16/01/2016] id: GU Catheter Size el: 0 cu: CCU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 16/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 16/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Crackles st: NotStopd t0: [08:00:00 16/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Crackles st: NotStopd t0: [08:00:00 16/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Stimul st: NotStopd t0: [08:00:00 16/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 16/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 16/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 16/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 16/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 16/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [08:00:00 16/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 16/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 16/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [08:00:00 16/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 16/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 16/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [08:00:00 16/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 16/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd
t0: [08:00:00 16/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 16/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 16/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 16/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 16/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 16/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 16/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [08:00:00 16/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd
t0: [09:00:00 16/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: None st: NotStopd
t0: [09:00:00 16/01/2016] id: BSA - English el: 0 cu: CCU cg: RN v1: 1.16511 u1: m2 st: NotStopd t0: [09:00:00 16/01/2016] id: BSA - Metric el: 0 cu: CCU cg: RN v1: 1.36146 u1: m2 st: NotStopd t0: [09:00:00 16/01/2016] id: Daily Weight el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd
t0: [10:00:00 16/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 22 u1: mmHg st: NotStopd
t0: [09:00:00 16/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [09:00:00 16/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [09:00:00 16/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [09:00:00 16/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [10:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 58 u1: BPM st: NotStopd t0: [10:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [10:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 129 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [10:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [10:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:00:00 16/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [10:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [10:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [10:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml
t0: [10:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [10:15:00 16/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 88 rs: Manual st: NotStopd
t0: [10:00:00 16/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [10:00:00 16/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [10:00:00 16/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97 u1: Deg. F st: NotStopd
t0: [12:00:00 16/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 108 rs: Manual st: NotStopd
tf: [12:00:00 16/01/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Fentanyl Citrate v1: 5000 u1: mcg m2: Soln. v2: 100 u2: ml tf: [09:00:00 11/02/2016] pt: Unit Dose rt: SC fr: Q8H fs: 12, 20, 4 dn: 3 m1: Heparin v1: 5000 u1: UNIT
t0: [12:00:00 16/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [12:00:00 16/01/2016] id: ETT Position Change el: 0 cu: CCU cg: RRT v1: Done st: NotStopd t0: [12:00:00 16/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 16/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [12:00:00 16/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [12:00:00 16/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 16/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 16/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 16/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 16/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [12:00:00 16/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 16/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 16/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 8.78 u1: L/min st: NotStopd t0: [12:00:00 16/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 16/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 16/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [12:00:00 16/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [12:00:00 16/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [12:00:00 16/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [12:00:00 16/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 99 u1: % st: NotStopd t0: [12:00:00 16/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [12:00:00 16/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [12:00:00 16/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [12:00:00 16/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [12:00:00 16/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [12:00:00 16/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 293 u1: ml/B st: NotStopd t0: [12:00:00 16/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [12:00:00 16/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 16/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [12:00:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [12:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [12:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 64 u1: BPM st: NotStopd t0: [12:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 16/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 16/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 128 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [12:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [12:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [12:00:00 16/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [12:00:00 16/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 16/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 16/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [12:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [12:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [12:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [12:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [12:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [12:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [12:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [08:00:00 16/01/2016] tf: [18:30:00 19/01/2016] dt: 4950 id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 12 vu: ml t0: [12:00:00 16/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 40 vu: ml
t0: [08:00:00 16/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [08:00:00 16/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd
t0: [10:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml nb: 1 t0: [10:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml nb: 1 t0: [10:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml nb: 1
t0: [13:00:00 16/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [13:00:00 16/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.5556 u1: Deg. C st: NotStopd t0: [13:00:00 16/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 96 u1: Deg. F st: NotStopd
pt: TPN tf: [10:00:00 17/01/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Fentanyl Citrate v1: 5000 u1: mcg m2: Soln. v2: 100 u2: ml
t0: [14:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 53 u1: BPM st: NotStopd t0: [14:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [14:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 134 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [14:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [14:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:00:00 16/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [14:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [14:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [14:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [14:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [14:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [14:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [14:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [14:17:00 16/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.33 rs: Final st: NotStopd t0: [14:17:00 16/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 94 rs: Final st: NotStopd t0: [14:17:00 16/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 0 rs: Final st: NotStopd t0: [14:17:00 16/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 28 rs: Final st: NotStopd t0: [14:17:00 16/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 50 u1: mmHg rs: Final st: NotStopd t0: [14:17:00 16/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 156 u1: mmHg rs: Final st: NotStopd t0: [14:17:00 16/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.33 rs: Final st: NotStopd t0: [14:17:00 16/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 94 rs: Final st: NotStopd
t0: [15:00:00 16/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [15:00:00 16/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.5556 u1: Deg. C st: NotStopd t0: [15:00:00 16/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 96 u1: Deg. F st: NotStopd
t0: [14:00:00 16/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [14:00:00 16/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [14:00:00 16/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [15:00:00 16/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [15:00:00 16/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [15:00:00 16/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [15:00:00 16/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 16/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 16/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Stimul st: NotStopd t0: [15:00:00 16/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [15:00:00 16/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [15:00:00 16/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 16/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 16/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [15:00:00 16/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd
t0: [15:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml
t0: [15:00:00 16/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [15:00:00 16/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [15:00:00 16/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [15:00:00 16/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [15:00:00 16/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [15:00:00 16/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [15:00:00 16/01/2016] id: INV Line#3 Type/Site el: 0 cu: CCU cg: RN v1: Introducer v2: Right IJ st: NotStopd t0: [15:00:00 16/01/2016] id: INV Line#3InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd
t0: [15:00:00 16/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 18 u1: mmHg st: NotStopd
t0: [15:00:00 16/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 0 vu: ml nb: 1
t0: [16:00:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [16:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 62 u1: BPM st: NotStopd t0: [16:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 136 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [16:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [16:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [16:00:00 16/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [16:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [16:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [16:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [16:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [16:00:00 16/01/2016] tf: [10:00:00 18/01/2016] dt: 2520 id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 10 vu: ml t0: [16:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [16:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [16:00:00 16/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [16:00:00 16/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 16/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [16:00:00 16/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [16:00:00 16/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [16:00:00 16/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [16:00:00 16/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 16/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 16/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [16:00:00 16/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 16/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 16/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.19 u1: L/min st: NotStopd t0: [16:00:00 16/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 16/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 16/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [16:00:00 16/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [16:00:00 16/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [16:00:00 16/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [16:00:00 16/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [16:00:00 16/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [16:00:00 16/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [16:00:00 16/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 298 u1: ml/B st: NotStopd t0: [16:00:00 16/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [16:00:00 16/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 16/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [16:00:00 16/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 22 vu: ml
t0: [23:00:00 16/01/2016] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: RN cv: 250 ap: none
t0: [17:45:00 16/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 101 rs: Manual st: NotStopd
tf: [12:00:00 17/01/2016] pt: IV Piggyback rt: IV fr: Q12H fs: 18, 6 dn: 2 m1: Cefepime v1: 2 u1: gm m2: D5W v2: 100 u2: ml
t0: [16:00:00 16/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 16/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [18:00:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [18:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [18:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 64 u1: BPM st: NotStopd t0: [18:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 141 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [18:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [18:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:00:00 16/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [18:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [18:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [18:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml nb: 1 t0: [18:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [18:00:00 16/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [18:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [18:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [18:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 16/01/2016] dt: 24 id: Chest Tube Out Total el: 1 cu: CCU cg: RN cv: 50 ap: none
t0: [18:00:00 16/01/2016] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: Tan v2: Thick st: NotStopd t0: [18:00:00 16/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: Scant st: NotStopd
t0: [14:00:00 16/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 16/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 16/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 16/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 16/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 16/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 16/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 16/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 16/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 16/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [14:00:00 16/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Problem st: NotStopd t0: [14:00:00 16/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [14:00:00 16/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Rarely Moist st: NotStopd t0: [14:00:00 16/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [14:00:00 16/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [14:00:00 16/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd
t0: [10:00:00 16/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 16/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 16/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 16/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 16/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 16/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 16/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [18:00:00 16/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 16/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [18:00:00 16/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 16/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [18:00:00 16/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 16/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 16/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 16/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd
t0: [20:00:00 16/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [20:00:00 16/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 16/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [20:00:00 16/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [20:00:00 16/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 16/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 16/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 16/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 16/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 8 st: NotStopd t0: [20:00:00 16/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 16/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 16/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.5 u1: L/min st: NotStopd t0: [20:00:00 16/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 16/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 16/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [20:00:00 16/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [20:00:00 16/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 16/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 16/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 99 u1: % st: NotStopd t0: [20:00:00 16/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [20:00:00 16/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 315 u1: ml/B st: NotStopd t0: [20:00:00 16/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [20:00:00 16/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 16/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [20:30:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [20:30:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:30:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:30:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:30:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:30:00 16/01/2016] id: Alarms el: 0 cu: CCU cg: RN v1: ON st: NotStopd t0: [20:30:00 16/01/2016] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:30:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 62 u1: BPM st: NotStopd t0: [20:30:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [20:30:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 132 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [20:30:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [20:30:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:30:00 16/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [20:30:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 12 u1: BPM st: NotStopd t0: [20:30:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [20:30:00 16/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [20:30:00 16/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [20:30:00 16/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.4 u1: Deg. F st: NotStopd t0: [20:30:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:30:00 16/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 104 rs: Manual st: NotStopd
t0: [20:30:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 25 vu: ml t0: [20:30:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 145.75 vu: ml t0: [20:30:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 5 vu: ml t0: [20:30:00 16/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 25 vu: ml t0: [20:30:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.75 vu: ml t0: [20:30:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 5 vu: ml
t0: [20:30:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:30:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:30:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [03:58:00 16/01/2016] id: Vancomycin/Random Drug Level el: 0 cu: CCU cg: 140 v1: 19.2 rs: Final st: NotStopd
t0: [22:00:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [22:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 66 u1: BPM st: NotStopd t0: [22:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 135 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [22:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [22:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:00:00 16/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [22:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 15 u1: BPM st: NotStopd t0: [22:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [22:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 15 vu: ml t0: [22:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 87.45 vu: ml t0: [22:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 3 vu: ml t0: [22:00:00 16/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 15 vu: ml t0: [22:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.25 vu: ml t0: [22:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [22:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 16/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [23:00:00 16/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [23:00:00 16/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [23:00:00 16/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [23:00:00 16/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [23:00:00 16/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [23:00:00 16/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [23:00:00 16/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [23:00:00 16/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [23:00:00 16/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [23:00:00 16/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [23:00:00 16/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [23:00:00 16/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [23:00:00 16/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [23:00:00 16/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [23:00:00 16/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [23:00:00 16/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [23:00:00 16/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 97 u1: % st: NotStopd t0: [23:00:00 16/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [23:00:00 16/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [23:00:00 16/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [23:00:00 16/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [23:00:00 16/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 16/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [23:00:00 16/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd
t0: [23:00:00 16/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [23:00:00 16/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 16/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [23:00:00 16/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 16/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 16/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 61 u1: BPM st: NotStopd t0: [23:00:00 16/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 16/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 124 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [23:00:00 16/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [23:00:00 16/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [23:00:00 16/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [23:00:00 16/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 24 u1: BPM st: NotStopd t0: [23:00:00 16/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [23:00:00 16/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [23:00:00 16/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [23:00:00 16/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 16/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 99 rs: Manual st: NotStopd
t0: [23:00:00 16/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 16/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [23:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [23:00:00 16/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 10 vu: ml t0: [23:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 1.5 vu: ml t0: [23:00:00 16/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2 vu: ml
t0: [23:00:00 16/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 16/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 16/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 16/01/2016] dt: 24 id: Tube Feeds In Total el: 1 cu: CCU cg: RN pv: 10 cv: 80 ap: none
t0: [01:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [01:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:00:00 17/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 63 u1: BPM st: NotStopd t0: [01:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 132 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [01:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [01:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [01:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 12 u1: BPM st: NotStopd t0: [01:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [01:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [03:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [03:00:00 17/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [03:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 137 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [03:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [03:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [03:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [03:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 31 u1: BPM st: NotStopd t0: [03:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 97 u1: % st: NotStopd t0: [03:00:00 17/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [03:00:00 17/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [03:00:00 17/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [03:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [01:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [01:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [01:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [01:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [01:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml t0: [03:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [03:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [03:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [03:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [03:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [03:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [01:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [03:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [04:02:00 17/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.31 rs: Final st: NotStopd t0: [04:02:00 17/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 1 rs: Final st: NotStopd t0: [04:02:00 17/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 30 rs: Final st: NotStopd t0: [04:02:00 17/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 57 u1: mmHg rs: Final st: NotStopd t0: [04:02:00 17/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 140 u1: mmHg rs: Final st: NotStopd t0: [04:02:00 17/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.31 rs: Final st: NotStopd
t0: [04:00:00 17/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [04:00:00 17/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 17/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:00:00 17/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [04:00:00 17/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 17/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 17/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 17/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 17/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [04:00:00 17/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 17/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 17/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [04:00:00 17/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 17/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 17/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 17/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 17/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 17/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 17/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 98 u1: % st: NotStopd t0: [04:00:00 17/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [04:00:00 17/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [04:00:00 17/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 325 u1: ml/B st: NotStopd t0: [04:00:00 17/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [04:00:00 17/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 17/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [03:30:00 17/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 14.3 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 14.3 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 32.6 u1: % rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 10.1 u1: gm/dl rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 413 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 3.38 u1: /mic l rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 14.3 rs: Final st: NotStopd
t0: [03:30:00 17/01/2016] id: PT el: 0 cu: CCU cg: 140 v1: 13.6 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: INR Coags el: 0 cu: CCU cg: 140 v1: 1.2 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: PTT Coags el: 0 cu: CCU cg: 140 v1: 29.4 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CCU cg: 140 v1: 1.2 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: PT(11-13.5) Coags el: 0 cu: CCU cg: 140 v1: 13.6 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: PTT(22-35) Coags el: 0 cu: CCU cg: 140 v1: 29.4 rs: Final st: NotStopd
t0: [03:30:00 17/01/2016] id: BUN el: 0 cu: CCU cg: 140 v1: 84 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 9 u1: mg/dl rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 110 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 2.3 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 97 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 2.5 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 3.6 u1: mEq/L rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 3.9 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 146 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Total Bili Chemistry el: 0 cu: CCU cg: 140 v1: 0.9 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: ALT Enzymes el: 0 cu: CCU cg: 140 v1: 4 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: AST Enzymes el: 0 cu: CCU cg: 140 v1: 5 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Alk. Phosphate Enzymes el: 0 cu: CCU cg: 140 v1: 89 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 84 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 9 u1: mg/dl rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 24 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 110 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 2.3 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 97 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 2.5 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 3.6 u1: mEq/L rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 3.9 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 146 rs: Final st: NotStopd t0: [03:30:00 17/01/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: CCU cg: 140 v1: 0.9 rs: Final st: NotStopd
t0: [05:00:00 17/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 17/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [05:00:00 17/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [05:00:00 17/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 17/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [05:00:00 17/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [05:00:00 17/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [05:00:00 17/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [05:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 17/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [05:00:00 17/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 17/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [05:00:00 17/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [05:00:00 17/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [05:00:00 17/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [05:00:00 17/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [05:00:00 17/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 17/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [05:00:00 17/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [05:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [05:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 17/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [05:00:00 17/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 17/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 17/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [05:00:00 17/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [05:00:00 17/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm Distended st: NotStopd t0: [05:00:00 17/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [05:00:00 17/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [05:00:00 17/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [05:00:00 17/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [05:00:00 17/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 17/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 17/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Stimul st: NotStopd t0: [05:00:00 17/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [05:00:00 17/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [05:00:00 17/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 151 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [05:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [05:00:00 17/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [05:00:00 17/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 17/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 17/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [05:00:00 17/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 17/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [05:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 27 u1: BPM st: NotStopd t0: [05:00:00 17/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [05:00:00 17/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [05:00:00 17/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [05:00:00 17/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [05:00:00 17/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [05:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 17/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 17/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [05:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 17/01/2016] id: Behavior el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 17/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [05:00:00 17/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [05:00:00 17/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 17/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 17/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [05:00:00 17/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [05:00:00 17/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [05:00:00 17/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd
t0: [05:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [05:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [05:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [05:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [05:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [05:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [05:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [07:00:00 17/01/2016] id: RSBI Not Completed el: 0 cu: CCU cg: RRT v1: Other/Remarks st: NotStopd
t0: [08:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [08:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 17/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Agitated st: NotStopd t0: [08:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [08:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 144 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [08:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [08:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [08:00:00 17/01/2016] id: Radiologic Study el: 0 cu: CCU cg: RN v1: Chest Xray st: NotStopd t0: [08:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 26 u1: BPM st: NotStopd t0: [08:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 17/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [08:00:00 17/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [08:00:00 17/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [08:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 30 vu: ml t0: [08:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 174.9 vu: ml t0: [08:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 6 vu: ml t0: [08:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [08:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4.5 vu: ml t0: [08:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 6 vu: ml
t0: [08:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [03:30:00 17/01/2016] id: Vancomycin/Random Drug Level el: 0 cu: CCU cg: 140 v1: 14.6 rs: Final st: NotStopd t0: [08:00:00 17/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [08:00:00 17/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 17/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 17/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [08:00:00 17/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 17/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 17/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 17/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 17/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [08:00:00 17/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 17/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 17/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [08:00:00 17/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 17/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 17/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [08:00:00 17/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [08:00:00 17/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 17/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 17/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 17/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [08:00:00 17/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [08:00:00 17/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [08:00:00 17/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [08:00:00 17/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [08:00:00 17/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:00:00 17/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [08:00:00 17/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 17/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [09:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [09:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 17/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 64 u1: BPM st: NotStopd t0: [09:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 149 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [09:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [09:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [09:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [09:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [09:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 17/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 50 vu: ml
t0: [09:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [10:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [10:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 63 u1: BPM st: NotStopd t0: [10:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 154 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [10:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [10:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [10:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [10:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [10:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [10:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [10:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [10:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [10:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [10:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
tf: [11:00:00 17/01/2016] pt: Unit Dose rt: PO fr: Q8H fs: 11, 19, 3 dn: 3 m1: Aluminum Hydroxide Suspension v1: 20 u1: ml tf: [10:00:00 18/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Albumin 25% (12.5gm) v1: 25 u1: gm tf: [20:00:00 23/01/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Fentanyl Citrate v1: 2500 u1: mcg m2: Soln. v2: 50 u2: ml tf: [17:00:00 24/01/2016] pt: Unit Dose rt: PO fr: Q4-6H:PRN m1: Lorazepam v1: 0.5-2 u1: mg tf: [18:00:00 25/01/2016] pt: IV Piggyback rt: IV DRIP fr: TITRATE TO m1: Midazolam HCl v1: 100 u1: mg m2: D5W v2: 100 u2: ml
pt: TPN
t0: [08:00:00 17/01/2016] id: Less Restrict Meas. el: 0 cu: CCU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 17/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [08:00:00 17/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 17/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 17/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 17/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 17/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 17/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 17/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 17/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [10:00:00 17/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [10:00:00 17/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [10:00:00 17/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 17/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [10:00:00 17/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [10:00:00 17/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 17/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [10:00:00 17/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [10:00:00 17/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [10:00:00 17/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [10:00:00 17/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [10:00:00 17/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [10:00:00 17/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 17/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [10:00:00 17/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 17/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm Distended st: NotStopd t0: [10:00:00 17/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [10:00:00 17/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [10:00:00 17/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [10:00:00 17/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [10:00:00 17/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [10:00:00 17/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 17/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 17/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [10:00:00 17/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [10:00:00 17/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [10:00:00 17/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 17/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [10:00:00 17/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [10:00:00 17/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [10:00:00 17/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [10:00:00 17/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 17/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [10:00:00 17/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [10:00:00 17/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 17/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 17/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [10:00:00 17/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 17/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 17/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 17/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 17/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [10:00:00 17/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [10:00:00 17/01/2016] id: Support Systems el: 0 cu: CCU cg: RN v1: Spouse st: NotStopd t0: [10:00:00 17/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [10:00:00 17/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [10:00:00 17/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [10:00:00 17/01/2016] id: Behavior el: 0 cu: CCU cg: RN v1: Restless st: NotStopd t0: [10:00:00 17/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [10:00:00 17/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [10:00:00 17/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [10:00:00 17/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [10:00:00 17/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [10:00:00 17/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [10:00:00 17/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 12 u1: number st: NotStopd t0: [10:00:00 17/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [10:00:00 17/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [10:00:00 17/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [10:00:00 17/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [10:00:00 17/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [10:00:00 17/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [10:00:00 17/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [10:00:00 17/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [11:00:00 17/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [11:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [11:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [11:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 17/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 17/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [11:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 67 u1: BPM st: NotStopd t0: [11:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 17/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [11:00:00 17/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [11:00:00 17/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [11:00:00 17/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [11:00:00 17/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [11:00:00 17/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 17/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 17/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 17/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [11:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 178 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [11:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [11:00:00 17/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [11:00:00 17/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [11:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [11:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 34 u1: BPM st: NotStopd t0: [11:00:00 17/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 17/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Side to Side st: NotStopd t0: [11:00:00 17/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 17/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 96 rs: Manual st: NotStopd t0: [12:00:00 17/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [12:00:00 17/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [12:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [12:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 165 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [12:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [12:00:00 17/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [12:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [12:00:00 17/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 17/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [12:00:00 17/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 17/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 17/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 17/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 17/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 93 rs: Manual st: NotStopd
t0: [12:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [12:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [12:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [12:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [12:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [12:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [11:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [12:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 17/01/2016] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: RN cv: 320 ap: none
tf: [11:00:00 19/01/2016] pt: IV Piggyback rt: IV fr: Q16H dn: 1 m1: Cefepime v1: 2 u1: gm m2: D5W v2: 100 u2: ml
t0: [13:00:00 17/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [13:00:00 17/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [13:00:00 17/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [13:00:00 17/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [13:00:00 17/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:00:00 17/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [13:00:00 17/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [13:00:00 17/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [13:00:00 17/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [13:00:00 17/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [13:00:00 17/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [13:00:00 17/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.37 u1: L/min st: NotStopd t0: [13:00:00 17/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:00:00 17/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [13:00:00 17/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [13:00:00 17/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [13:00:00 17/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [13:00:00 17/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [13:00:00 17/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [13:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 100 u1: % st: NotStopd t0: [13:00:00 17/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [13:00:00 17/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [13:00:00 17/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [13:00:00 17/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [13:00:00 17/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [13:00:00 17/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 302 u1: ml/B st: NotStopd t0: [13:00:00 17/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [13:00:00 17/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [13:00:00 17/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [13:15:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [13:15:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [13:15:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [13:15:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:15:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 81 u1: BPM st: NotStopd t0: [13:15:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [13:15:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 197 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [13:15:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 118 u1: mmHg st: NotStopd t0: [13:15:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [13:15:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [13:15:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 36 u1: BPM st: NotStopd t0: [13:15:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [13:15:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:15:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:15:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [13:15:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [14:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [14:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 66 u1: BPM st: NotStopd t0: [14:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 176 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [14:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [14:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [14:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 18 u1: BPM st: NotStopd t0: [14:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 50 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [14:00:00 17/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 17/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Agitated st: NotStopd t0: [14:00:00 17/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 17/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 17/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 73 rs: Manual st: NotStopd
t0: [14:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [14:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [14:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [14:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [14:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2 vu: ml t0: [14:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [14:00:00 17/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Axillary st: NotStopd t0: [14:00:00 17/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 35.5556 u1: Deg. C st: NotStopd t0: [14:00:00 17/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 96 u1: Deg. F st: NotStopd t0: [15:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [15:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [15:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 79 u1: BPM st: NotStopd t0: [15:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 217 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [15:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 127 u1: mmHg st: NotStopd t0: [15:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [15:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [15:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 37 u1: BPM st: NotStopd t0: [15:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [15:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [15:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [15:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 1 vu: ml t0: [15:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 1.5 vu: ml
t0: [15:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [16:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [16:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [16:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 184 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [16:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [16:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [16:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [16:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [16:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip
tf: [17:00:00 19/01/2016] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Calcium Carbonate v1: 1000 u1: mg
t0: [14:00:00 17/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 17/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 17/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 17/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 17/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 17/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 17/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 17/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 17/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 17/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 17/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [16:00:00 17/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 17/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [16:00:00 17/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 17/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 17/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 17/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [16:00:00 17/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 17/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 17/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [16:00:00 17/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 17/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 17/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 17/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 17/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm Distended st: NotStopd t0: [16:00:00 17/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 17/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [16:00:00 17/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 17/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [16:00:00 17/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 17/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 17/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 17/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 17/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 17/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 17/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 17/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 17/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 17/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 17/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 17/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [16:00:00 17/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 17/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 17/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 17/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [16:00:00 17/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [16:00:00 17/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 17/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 17/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [16:00:00 17/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 17/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 17/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 17/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 17/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 17/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 17/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 117 rs: Manual st: NotStopd t0: [16:00:00 17/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [16:00:00 17/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 17/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: No Apparent Prob st: NotStopd t0: [16:00:00 17/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 17/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 17/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 17/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 13 u1: number st: NotStopd t0: [16:00:00 17/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 17/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [16:00:00 17/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd t0: [16:00:00 17/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 17/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [16:00:00 17/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 17/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [16:00:00 17/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Sanguinous st: NotStopd
t0: [16:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [16:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 0 vu: ml t0: [16:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [16:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 1.5 vu: ml t0: [16:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 1.5 vu: ml
t0: [16:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [17:00:00 17/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [17:00:00 17/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 17/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [17:00:00 17/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [17:00:00 17/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 17/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 17/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 17/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 17/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [17:00:00 17/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 17/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:00:00 17/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [17:00:00 17/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 17/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 17/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [17:00:00 17/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [17:00:00 17/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [17:00:00 17/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [17:00:00 17/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [17:00:00 17/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [17:00:00 17/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:3 st: NotStopd t0: [17:00:00 17/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [17:00:00 17/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [17:00:00 17/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [17:00:00 17/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [17:00:00 17/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [17:00:00 17/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 17/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: SQUARE st: NotStopd
t0: [17:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [17:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [17:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [17:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 176 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [17:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [17:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [17:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [17:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 17/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [18:00:00 17/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 17/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [18:00:00 17/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 17/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [18:00:00 17/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [18:00:00 17/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 17/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 17/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd
t0: [18:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [18:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [18:00:00 17/01/2016] tf: [17:00:00 18/01/2016] dt: 1380 id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [18:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [18:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [18:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [17:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [18:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [18:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [18:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 75 u1: BPM st: NotStopd t0: [18:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 197 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [18:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 121 u1: mmHg st: NotStopd t0: [18:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [18:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 19 u1: BPM st: NotStopd t0: [18:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 17/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 93 rs: Manual st: NotStopd
t0: [18:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [20:00:00 17/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [20:00:00 17/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 17/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 17/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [20:00:00 17/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:00:00 17/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [20:00:00 17/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 17/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 17/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [20:00:00 17/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [20:00:00 17/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 17/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 17/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [20:00:00 17/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [20:00:00 17/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 17/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 17/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:00:00 17/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [20:00:00 17/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [20:00:00 17/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [20:00:00 17/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [20:00:00 17/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [20:00:00 17/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [20:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 17/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [20:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 167 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [20:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [20:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [20:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [20:00:00 17/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [20:00:00 17/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [20:00:00 17/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [20:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 17/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 101 rs: Manual st: NotStopd
t0: [20:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [20:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [20:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [20:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [20:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [20:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [20:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
tf: [12:00:00 23/01/2016] pt: Unit Dose rt: IV fr: BID fs: 10, 22 dn: 2 m1: Bumetanide v1: 2 u1: mg
t0: [20:00:00 17/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT st: NotStopd t0: [00:00:00 18/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [00:00:00 18/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 18/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [00:00:00 18/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [00:00:00 18/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 18/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 18/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 18/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 18/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [00:00:00 18/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 18/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 18/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [00:00:00 18/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 18/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 18/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 18/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [00:00:00 18/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [00:00:00 18/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [00:00:00 18/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 18/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [00:00:00 18/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [00:00:00 18/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [00:00:00 18/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [00:00:00 18/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [00:00:00 18/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd
t0: [00:36:00 18/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.35 rs: Final st: NotStopd t0: [00:36:00 18/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 3 rs: Final st: NotStopd t0: [00:36:00 18/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 32 rs: Final st: NotStopd t0: [00:36:00 18/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 55 u1: mmHg rs: Final st: NotStopd t0: [00:36:00 18/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 179 u1: mmHg rs: Final st: NotStopd t0: [00:36:00 18/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.35 rs: Final st: NotStopd
t0: [22:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [22:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:00:00 17/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 63 u1: BPM st: NotStopd t0: [22:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 153 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [22:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [22:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [22:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [22:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 17/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [23:00:00 17/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 17/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [23:00:00 17/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 17/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 17/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 64 u1: BPM st: NotStopd t0: [23:00:00 17/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 17/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 141 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [23:00:00 17/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [23:00:00 17/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [23:00:00 17/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [23:00:00 17/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 30 u1: BPM st: NotStopd t0: [23:00:00 17/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 17/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [00:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [00:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 166 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [00:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [00:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [00:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [00:00:00 18/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [00:00:00 18/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [00:00:00 18/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.2 u1: Deg. F st: NotStopd t0: [00:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 17/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 30 vu: ml t0: [23:00:00 17/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 174.9 vu: ml t0: [23:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 3 vu: ml t0: [23:00:00 17/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 60 vu: ml t0: [23:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4.5 vu: ml t0: [23:00:00 17/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4.5 vu: ml t0: [00:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [00:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [00:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [00:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 1.5 vu: ml t0: [00:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 1.5 vu: ml
t0: [22:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip t0: [23:00:00 17/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 17/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 17/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip t0: [00:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 17/01/2016] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN pv: 850 cv: 850 ap: none t0: [23:00:00 17/01/2016] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN pv: -573.1 cv: -573.1 ap: none t0: [23:00:00 17/01/2016] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN pv: 42 cv: 456 ap: none t0: [23:00:00 17/01/2016] dt: 24 id: IV Nutrition Total el: 1 cu: CCU cg: RN pv: 174.9 cv: 1399.2 ap: none t0: [23:00:00 17/01/2016] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN pv: 276.9 cv: 2555.2 ap: none t0: [23:00:00 17/01/2016] dt: 24 id: Tube Feeds In Total el: 1 cu: CCU cg: RN pv: 60 cv: 380 ap: none t0: [23:00:00 17/01/2016] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN pv: 850 cv: 3000 ap: none t0: [23:00:00 17/01/2016] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN pv: -573.1 cv: -444.8 ap: none t0: [23:00:00 17/01/2016] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN pv: 850 cv: 3000 ap: none t0: [23:00:00 17/01/2016] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN pv: -573.1 cv: 14570.2 ap: carryForward t0: [23:00:00 18/01/2016] dt: 24 id: PO/Gastric In Total el: 1 cu: CCU cg: RN cv: 1086 ap: none
t0: [00:45:00 18/01/2016] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 8.9 u1: mg/dl rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 110 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 1.8 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 121 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 2.3 u1: mEq/L rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 3 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 145 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 8.9 u1: mg/dl rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 26 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 110 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 1.8 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 121 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 2.3 u1: mEq/L rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 3 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 145 rs: Final st: NotStopd
t0: [00:45:00 18/01/2016] id: BUN el: 0 cu: CCU cg: 140 v1: 73 rs: Final st: NotStopd t0: [00:45:00 18/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 73 rs: Final st: NotStopd
t0: [02:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [02:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [02:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [02:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 162 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [02:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [02:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [02:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [02:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [02:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [02:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [02:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [02:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [02:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [02:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [02:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 18/01/2016] dt: 1 id: Total Hourly Output el: 1 cu: CCU cg: RN pv: 300 cv: 300 ap: none t0: [23:00:00 18/01/2016] dt: 1 id: Net Hourly Balance el: 1 cu: CCU cg: RN pv: -185.7 cv: -185.7 ap: none t0: [23:00:00 18/01/2016] dt: 24 id: IV Infusion In Total el: 1 cu: CCU cg: RN pv: 16 cv: 717.75 ap: none t0: [23:00:00 18/01/2016] dt: 24 id: IV Nutrition Total el: 1 cu: CCU cg: RN pv: 58.3 cv: 1399.2 ap: none t0: [23:00:00 18/01/2016] dt: 24 id: 24h Total In el: 1 cu: CCU cg: RN pv: 114.3 cv: 3842.95 ap: none t0: [23:00:00 18/01/2016] dt: 24 id: Tube Feeds In Total el: 1 cu: CCU cg: RN pv: 40 cv: 640 ap: none t0: [23:00:00 18/01/2016] dt: 24 id: Urine Out Total el: 1 cu: CCU cg: RN pv: 300 cv: 4250 ap: none t0: [23:00:00 18/01/2016] dt: 24 id: 24h Net Body Balance el: 1 cu: CCU cg: RN pv: -185.7 cv: -442.05 ap: carryForward t0: [23:00:00 18/01/2016] dt: 24 id: 24h Total Out el: 1 cu: CCU cg: RN pv: 300 cv: 4285 ap: carryForward t0: [23:00:00 18/01/2016] dt: multiple days id: LOS Net Body Balance el: 1 cu: CCU cg: RN pv: -185.7 cv: 14128.2 ap: carryForward
t0: [04:00:00 18/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [04:00:00 18/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 18/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:00:00 18/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [04:00:00 18/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 18/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 18/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 18/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 18/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [04:00:00 18/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [04:00:00 18/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 18/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 18/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 18/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [04:00:00 18/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [04:00:00 18/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [04:00:00 18/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 18/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [04:00:00 18/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [04:00:00 18/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [04:00:00 18/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [04:00:00 18/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [04:00:00 18/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd
tf: [03:00:00 19/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 4 dn: 1 m1: Bumetanide v1: 2 u1: mg m2: D5W v2: 100 u2: ml
t0: [04:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [04:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 59 u1: BPM st: NotStopd t0: [04:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Sinus Brady st: NotStopd t0: [04:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 131 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [04:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [04:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [04:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [04:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 18/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 18/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [05:00:00 18/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [05:00:00 18/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 18/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [05:00:00 18/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [05:00:00 18/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [05:00:00 18/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [05:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 18/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [05:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 18/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [05:00:00 18/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [05:00:00 18/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [05:00:00 18/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [05:00:00 18/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [05:00:00 18/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 18/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [05:00:00 18/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [05:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 60 u1: BPM st: NotStopd t0: [05:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 18/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [05:00:00 18/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 18/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 18/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [05:00:00 18/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [05:00:00 18/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm Distended st: NotStopd t0: [05:00:00 18/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [05:00:00 18/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [05:00:00 18/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [05:00:00 18/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [05:00:00 18/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [05:00:00 18/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [05:00:00 18/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 18/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 18/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [05:00:00 18/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [05:00:00 18/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [05:00:00 18/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 132 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [05:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [05:00:00 18/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [05:00:00 18/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 18/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 18/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [05:00:00 18/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 18/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [05:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [05:00:00 18/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [05:00:00 18/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [05:00:00 18/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [05:00:00 18/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [05:00:00 18/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [05:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 18/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [05:00:00 18/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [05:00:00 18/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.4 u1: Deg. F st: NotStopd t0: [05:00:00 18/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 18/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [05:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 18/01/2016] id: Behavior el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 18/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [05:00:00 18/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [05:00:00 18/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [05:00:00 18/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 18/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Negative v2: Negative st: NotStopd t0: [05:00:00 18/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [05:00:00 18/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [05:00:00 18/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [04:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [04:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [04:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [04:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [04:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [04:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml t0: [05:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [05:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [05:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [05:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 1.5 vu: ml t0: [05:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 1.5 vu: ml
t0: [04:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip t0: [05:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [05:00:00 18/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 14.6 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 14.6 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 33 u1: % rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 10.1 u1: gm/dl rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 450 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 3.47 u1: /mic l rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 14.6 rs: Final st: NotStopd
t0: [05:00:00 18/01/2016] id: BUN el: 0 cu: CCU cg: 140 v1: 72 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 8.8 u1: mg/dl rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 111 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 165 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 2.2 u1: mEq/L rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 3.6 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 145 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 72 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 8.8 u1: mg/dl rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 27 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 111 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 165 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 2.2 u1: mEq/L rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 3.6 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 145 rs: Final st: NotStopd
t0: [05:00:00 18/01/2016] id: PT el: 0 cu: CCU cg: 140 v1: 14 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: INR Coags el: 0 cu: CCU cg: 140 v1: 1.3 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: PTT Coags el: 0 cu: CCU cg: 140 v1: 31.1 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CCU cg: 140 v1: 1.3 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: PT(11-13.5) Coags el: 0 cu: CCU cg: 140 v1: 14 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: PTT(22-35) Coags el: 0 cu: CCU cg: 140 v1: 31.1 rs: Final st: NotStopd
t0: [05:00:00 18/01/2016] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 1.7 rs: Final st: NotStopd t0: [05:00:00 18/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 1.7 rs: Final st: NotStopd
t0: [06:30:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [07:00:00 18/01/2016] id: RSBI Not Completed el: 0 cu: CCU cg: RRT v1: Other/Remarks st: NotStopd
tf: [12:00:00 18/01/2016] pt: IV Piggyback rt: IV fr: Q2H fs: 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23 dn: 12 m1: Potassium Chloride v1: 20 u1: mEq m2: SW v2: 50 u2: ml
t0: [07:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [07:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [07:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [07:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 61 u1: BPM st: NotStopd t0: [07:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 135 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [07:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [07:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [07:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 72.5 u1: kg st: NotStopd t0: [07:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [07:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [07:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [07:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [07:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [07:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3.75 vu: ml
t0: [07:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [08:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 79 u1: BPM st: NotStopd t0: [08:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 188 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [08:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 126 u1: mmHg st: NotStopd t0: [08:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 27 u1: BPM st: NotStopd t0: [08:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [07:45:00 18/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [07:45:00 18/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [07:45:00 18/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [07:45:00 18/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [07:45:00 18/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [07:45:00 18/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [07:45:00 18/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [07:45:00 18/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:45:00 18/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [07:45:00 18/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:45:00 18/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:45:00 18/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.8 u1: L/min st: NotStopd t0: [07:45:00 18/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:45:00 18/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [07:45:00 18/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [07:45:00 18/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [07:45:00 18/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [07:45:00 18/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [07:45:00 18/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [07:45:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 100 u1: % st: NotStopd t0: [07:45:00 18/01/2016] id: Sputum Color/Consist el: 0 cu: CCU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [07:45:00 18/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [07:45:00 18/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [07:45:00 18/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:2.8 st: NotStopd t0: [07:45:00 18/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [07:45:00 18/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [07:45:00 18/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10.8 st: NotStopd t0: [07:45:00 18/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [07:45:00 18/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [07:45:00 18/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [07:45:00 18/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [07:00:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 132 rs: Manual st: NotStopd t0: [08:00:00 18/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 18/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 18/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 18/01/2016] id: Pain Present el: 0 cu: CCU cg: RN st: NotStopd t0: [08:00:00 18/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 18/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Grimace Scale st: NotStopd t0: [08:00:00 18/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 18/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 18/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 18/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 18/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 18/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [08:00:00 18/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 18/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [08:00:00 18/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 18/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 18/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 18/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 18/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 18/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 18/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 18/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 18/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [08:00:00 18/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [08:00:00 18/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 18/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 18/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 18/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 18/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 18/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 18/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 18/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 18/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 18/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 18/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 18/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [08:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [08:00:00 18/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 18/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 18/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [08:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 18/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [08:00:00 18/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [08:00:00 18/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [08:00:00 18/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 18/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 18/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 18/01/2016] id: BSA - English el: 0 cu: CCU cg: RN v1: 1.15792 u1: m2 st: NotStopd t0: [08:00:00 18/01/2016] id: BSA - Metric el: 0 cu: CCU cg: RN v1: 1.35322 u1: m2 st: NotStopd t0: [08:00:00 18/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 18/01/2016] id: Weight Change el: 0 cu: CCU cg: RN v1: 0 u1: kg st: NotStopd t0: [08:00:00 18/01/2016] id: Daily Weight el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [08:00:00 18/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [08:00:00 18/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 18/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 18/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 18/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 18/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [08:00:00 18/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [08:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [08:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [08:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 1.5 vu: ml t0: [08:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [06:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [06:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [06:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 64 u1: BPM st: NotStopd t0: [06:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 156 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [06:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [06:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [06:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [06:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 18/01/2016] id: Less Restrict Meas. el: 0 cu: CCU cg: RN v1: Medicated st: NotStopd t0: [08:00:00 18/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 18/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 18/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 18/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 18/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 18/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: CCU cg: RN v1: Normal Saline st: NotStopd t0: [08:00:00 18/01/2016] id: ImpSkin Character #2 el: 0 cu: CCU cg: RN v1: Blister st: NotStopd t0: [08:00:00 18/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CCU cg: RN v1: Serous st: NotStopd t0: [08:00:00 18/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 18/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Transparent st: NotStopd t0: [08:00:00 18/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 18/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [08:00:00 18/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 18/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CCU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [08:00:00 18/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 18/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 18/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 18/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CCU cg: RN v1: Dry Sterile Dsg v2: Intact st: NotStopd t0: [08:00:00 18/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 18/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 18/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 18/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 18/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 18/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 18/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 18/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 18/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 18/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 18/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [08:00:00 18/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 18/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 18/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 18/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 18/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 18/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 18/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Very Limited st: NotStopd t0: [09:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [09:00:00 18/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 11 u1: mmHg st: NotStopd t0: [09:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [09:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [09:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 176 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [09:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [09:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [09:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 36 u1: BPM st: NotStopd t0: [09:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 148 rs: Manual st: NotStopd
t0: [09:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [09:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 3 vu: ml t0: [09:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 1.5 vu: ml t0: [09:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 1.5 vu: ml
t0: [06:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip t0: [07:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip t0: [08:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip t0: [09:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [10:00:00 18/01/2016] id: Less Restrict Meas. el: 0 cu: CCU cg: RN v1: Medicated st: NotStopd t0: [10:00:00 18/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [10:00:00 18/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 14 u1: mmHg st: NotStopd t0: [10:00:00 18/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [10:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:00:00 18/01/2016] id: Dorsal PedPulse R/L el: 0 cu: CCU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [10:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 18/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [10:00:00 18/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 74 u1: BPM st: NotStopd t0: [10:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 18/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 18/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 18/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [10:00:00 18/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [10:00:00 18/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [10:00:00 18/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [10:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 190 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [10:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 119 u1: mmHg st: NotStopd t0: [10:00:00 18/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 18/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 1 Person Assist st: NotStopd t0: [10:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [10:00:00 18/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [10:00:00 18/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 18/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [10:00:00 18/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [10:00:00 18/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [10:00:00 18/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [10:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 18/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Back st: NotStopd t0: [10:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 20 vu: ml t0: [07:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [08:00:00 18/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 120 vu: ml t0: [08:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [09:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [10:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [10:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [10:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 0 vu: ml t0: [10:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 1.5 vu: ml t0: [10:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 1.5 vu: ml
t0: [10:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [10:00:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 100 rs: Manual st: NotStopd
t0: [10:30:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:30:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:30:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd
t0: [10:30:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [10:30:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [10:30:00 18/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 8 u1: mmHg st: NotStopd t0: [10:30:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:30:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:30:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [10:30:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 173 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [10:30:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [10:30:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:30:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [10:30:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [10:30:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [11:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2.5 vu: ml t0: [11:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 0 vu: ml t0: [11:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 1.5 vu: ml t0: [11:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 1.5 vu: ml
t0: [10:30:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 75 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:30:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [11:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [11:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 18/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [11:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [11:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 18/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 18/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 18/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 140 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [11:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [11:00:00 18/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [11:00:00 18/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [11:00:00 18/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [11:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [11:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 18/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [11:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [11:30:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 102 rs: Manual st: NotStopd
t0: [10:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 35 u1: BPM st: NotStopd t0: [10:30:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN u1: BPM st: NotStopd t0: [11:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [11:30:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:30:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:30:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 62 u1: BPM st: NotStopd t0: [11:30:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [11:30:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [11:30:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 18/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 40 vu: ml
t0: [12:00:00 18/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 18/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 18/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [12:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [12:00:00 18/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 18/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [12:00:00 18/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [12:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 18/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 18/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [12:00:00 18/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 18/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 18/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 71 u1: BPM st: NotStopd t0: [12:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 18/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 18/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 18/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 18/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 18/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 159 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [12:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [12:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [12:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [12:00:00 18/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 18/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 18/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [12:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd t0: [12:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 18/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [12:00:00 18/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [12:00:00 18/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [12:00:00 18/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 18/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 18/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [12:00:00 18/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [12:00:00 18/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 18/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 18/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [12:00:00 18/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [12:00:00 18/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [12:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [12:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [12:00:00 18/01/2016] tf: [01:00:00 19/01/2016] dt: 780 id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [12:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [12:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [12:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [12:50:00 18/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [12:50:00 18/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:50:00 18/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:50:00 18/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [12:50:00 18/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:50:00 18/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [12:50:00 18/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35.3 u1: Deg. C st: NotStopd t0: [12:50:00 18/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:50:00 18/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [12:50:00 18/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:50:00 18/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:50:00 18/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.7 u1: L/min st: NotStopd t0: [12:50:00 18/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:50:00 18/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [12:50:00 18/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [12:50:00 18/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [12:50:00 18/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [12:50:00 18/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [12:50:00 18/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:50:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:50:00 18/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [12:50:00 18/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:2.8 st: NotStopd t0: [12:50:00 18/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [12:50:00 18/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [12:50:00 18/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [12:50:00 18/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 315 u1: ml/B st: NotStopd t0: [12:50:00 18/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [12:50:00 18/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [12:50:00 18/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
pt: TPN
t0: [12:00:00 18/01/2016] id: Less Restrict Meas. el: 0 cu: CCU cg: RN v1: Medicated st: NotStopd t0: [12:00:00 18/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [12:00:00 18/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [12:00:00 18/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 18/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 18/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [12:00:00 18/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 18/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 18/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [12:00:00 18/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 18/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [12:00:00 18/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [12:00:00 18/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 18/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [12:00:00 18/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [13:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [13:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [13:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 66 u1: BPM st: NotStopd t0: [13:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 129 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [13:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [13:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [13:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [13:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [13:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [13:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [13:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [13:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [13:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [13:00:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 120 rs: Manual st: NotStopd
t0: [13:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd t0: [14:00:00 18/01/2016] id: Less Restrict Meas. el: 0 cu: CCU cg: RN v1: Medicated st: NotStopd t0: [14:00:00 18/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [14:00:00 18/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [14:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 18/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [14:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [14:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 18/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [14:00:00 18/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [14:00:00 18/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [14:00:00 18/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [14:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 140 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [14:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [14:00:00 18/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [14:00:00 18/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [14:00:00 18/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 36 u1: BPM st: NotStopd t0: [14:00:00 18/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [14:00:00 18/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [14:00:00 18/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [14:00:00 18/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [14:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [14:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [14:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [14:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [14:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [14:30:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 85 rs: Manual st: NotStopd
t0: [15:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [15:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [15:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [15:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 141 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [15:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [15:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [15:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [15:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd t0: [15:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [15:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [15:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [15:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [15:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [15:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [16:00:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 67 rs: Manual st: NotStopd
t0: [14:00:00 18/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 18/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 18/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 18/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 18/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [14:00:00 18/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 18/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [14:00:00 18/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [16:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [16:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 131 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [16:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [16:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [16:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [16:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 0 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [16:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [16:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [16:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [16:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [16:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [11:00:00 18/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 18/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 18/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 18/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 18/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RN v1: 25cm v2: Lip st: NotStopd t0: [14:00:00 18/01/2016] id: Airway Size el: 0 cu: CCU cg: RN v1: 7.5 mm st: NotStopd t0: [14:00:00 18/01/2016] id: Airway Type el: 0 cu: CCU cg: RN v1: Endotracheal st: NotStopd t0: [14:00:00 18/01/2016] id: Intubation Date el: 0 cu: CCU cg: RN v1: 12 v2: 23 st: NotStopd t0: [14:00:00 18/01/2016] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: White v2: Thick st: NotStopd t0: [14:00:00 18/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [14:00:00 18/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RN v1: Drager st: NotStopd t0: [16:00:00 18/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 18/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 18/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [16:00:00 18/01/2016] id: Less Restrict Meas. el: 0 cu: CCU cg: RN v1: Medicated st: NotStopd t0: [16:00:00 18/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Grimace Scale st: NotStopd t0: [16:00:00 18/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 18/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 18/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [16:00:00 18/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 18/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: H2 Blocker st: NotStopd t0: [16:00:00 18/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [16:00:00 18/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 18/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 18/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [16:00:00 18/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 18/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 18/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 18/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 18/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 18/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 18/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [16:00:00 18/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 18/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 18/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 18/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 18/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 18/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 18/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 18/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 18/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 18/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 18/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 18/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [16:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd t0: [16:00:00 18/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [16:00:00 18/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 18/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 18/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [16:00:00 18/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [16:00:00 18/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [16:00:00 18/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 18/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 18/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 18/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Hypoactive st: NotStopd t0: [16:00:00 18/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [16:00:00 18/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [16:00:00 18/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 18/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 18/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 18/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [16:00:00 18/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [17:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [17:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [17:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [17:00:00 18/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [17:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [17:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 18/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 18/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [17:00:00 18/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 146 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [17:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [17:00:00 18/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [17:00:00 18/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [17:00:00 18/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [17:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [17:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 33 u1: BPM st: NotStopd t0: [17:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 18/01/2016] id: Sputum Color/Consist el: 0 cu: CCU cg: RN v1: White v2: Thick st: NotStopd t0: [17:00:00 18/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [17:00:00 18/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [17:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [17:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 0 vu: ml t0: [17:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [17:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [17:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [17:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 18/01/2016] dt: 24 id: Chest Tube Out Total el: 1 cu: CCU cg: RN cv: 35 ap: none
t0: [16:50:00 18/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RT v1: 25cm v2: Lip st: NotStopd t0: [16:50:00 18/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RT v1: 0.4 u1: torr st: NotStopd t0: [16:50:00 18/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RT v1: 40 u1: cmH2O st: NotStopd t0: [16:50:00 18/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RT v1: 10 u1: BPM st: NotStopd t0: [16:50:00 18/01/2016] id: Airway Size el: 0 cu: CCU cg: RT v1: 7.5 mm st: NotStopd t0: [16:50:00 18/01/2016] id: Airway Type el: 0 cu: CCU cg: RT v1: Endotracheal st: NotStopd t0: [16:50:00 18/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RT v1: 35.5 u1: Deg. C st: NotStopd t0: [16:50:00 18/01/2016] id: Intubation Date el: 0 cu: CCU cg: RT v1: 12 v2: 23 st: NotStopd t0: [16:50:00 18/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RT v1: 7 st: NotStopd t0: [16:50:00 18/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RT v1: 6 v2: Albuterol st: NotStopd t0: [16:50:00 18/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RT v1: 6 v2: Atrovent st: NotStopd t0: [16:50:00 18/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RT v1: 10.5 u1: L/min st: NotStopd t0: [16:50:00 18/01/2016] id: PEEP Set el: 0 cu: CCU cg: RT v1: 5 u1: cmH2O st: NotStopd t0: [16:50:00 18/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RT v1: 20 st: NotStopd t0: [16:50:00 18/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RT v1: 28 u1: cmH2O st: NotStopd t0: [16:50:00 18/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RT v1: 0 u1: BPM st: NotStopd t0: [16:50:00 18/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RT v1: 32 u1: BPM st: NotStopd t0: [16:50:00 18/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RT v1: 32 u1: BPM st: NotStopd t0: [16:50:00 18/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RT v1: 10 u1: cmH2O st: NotStopd t0: [16:50:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RT v1: 100 u1: % st: NotStopd t0: [16:50:00 18/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RT v1: Insp. Time Fixed st: NotStopd t0: [16:50:00 18/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RT v1: 1:2.8 st: NotStopd t0: [16:50:00 18/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RT v1: 23 u1: cmH2O st: NotStopd t0: [16:50:00 18/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RT v1: 0.5 u1: sec st: NotStopd t0: [16:50:00 18/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RT v1: 11 st: NotStopd t0: [16:50:00 18/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RT v1: 340 u1: ml/B st: NotStopd t0: [16:50:00 18/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RT v1: Pressure Control st: NotStopd t0: [16:50:00 18/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RT v1: Drager st: NotStopd t0: [16:50:00 18/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RT v1: RAMP st: NotStopd
t0: [17:00:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 122 rs: Manual st: NotStopd
t0: [17:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [18:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [18:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [18:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [18:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 67 u1: BPM st: NotStopd t0: [18:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 155 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [18:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [18:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [18:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [18:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 18/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 50 vu: ml t0: [18:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [18:00:00 18/01/2016] tf: [18:30:00 19/01/2016] dt: 1470 id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [18:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 30 vu: ml t0: [18:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [18:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [18:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [16:59:00 18/01/2016] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 4.1 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 4.1 rs: Final st: NotStopd
t0: [16:59:00 18/01/2016] id: BUN el: 0 cu: CCU cg: 140 v1: 71 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 110 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 1.7 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 115 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 2 u1: mEq/L rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 146 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 71 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 29 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 110 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 1.7 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 115 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 2 u1: mEq/L rs: Final st: NotStopd t0: [16:59:00 18/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 146 rs: Final st: NotStopd
t0: [18:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [18:30:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 142 rs: Manual st: NotStopd
t0: [18:35:00 18/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.35 rs: Final st: NotStopd t0: [18:35:00 18/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [18:35:00 18/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 30 rs: Final st: NotStopd t0: [18:35:00 18/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 53 u1: mmHg rs: Final st: NotStopd t0: [18:35:00 18/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 165 u1: mmHg rs: Final st: NotStopd t0: [18:35:00 18/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.35 rs: Final st: NotStopd
t0: [19:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [19:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd
t0: [19:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [19:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [19:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [19:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [19:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [19:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [19:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [19:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [19:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 66 u1: BPM st: NotStopd t0: [19:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 134 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [19:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [19:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [19:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [19:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
tf: [18:00:00 19/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 19 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [19:00:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 135 rs: Manual st: NotStopd
t0: [19:45:00 18/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [19:45:00 18/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [19:45:00 18/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [19:45:00 18/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [19:45:00 18/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [19:45:00 18/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [19:45:00 18/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35.5 u1: Deg. C st: NotStopd t0: [19:45:00 18/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [19:45:00 18/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [19:45:00 18/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [19:45:00 18/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [19:45:00 18/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 9.77 u1: L/min st: NotStopd t0: [19:45:00 18/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [19:45:00 18/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [19:45:00 18/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [19:45:00 18/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [19:45:00 18/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [19:45:00 18/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [19:45:00 18/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [19:45:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 100 u1: % st: NotStopd t0: [19:45:00 18/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [19:45:00 18/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:2.8 st: NotStopd t0: [19:45:00 18/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [19:45:00 18/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [19:45:00 18/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [19:45:00 18/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [19:45:00 18/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [19:45:00 18/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [19:45:00 18/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [20:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [20:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [20:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 66 u1: BPM st: NotStopd t0: [20:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 118 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [20:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [20:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [20:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [20:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [20:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [20:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 18/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [21:00:00 18/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Grimace Scale st: NotStopd t0: [21:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [21:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 18/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 18/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [21:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 144 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [21:00:00 18/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [21:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [21:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [21:00:00 18/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [21:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [21:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 0 u1: BPM st: NotStopd t0: [21:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [20:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [20:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [20:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [20:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml t0: [21:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [21:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [21:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [21:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [21:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [20:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip t0: [21:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
id: Free Water Bolus el: 1 cu: CCU cg: RN io: Free Water Bolus PO/Gastric du: ml rt: Nasogastric
t0: [21:47:00 18/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.34 rs: Final st: NotStopd t0: [21:47:00 18/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [21:47:00 18/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 31 rs: Final st: NotStopd t0: [21:47:00 18/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 55 u1: mmHg rs: Final st: NotStopd t0: [21:47:00 18/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 175 u1: mmHg rs: Final st: NotStopd t0: [21:47:00 18/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.34 rs: Final st: NotStopd
t0: [21:47:00 18/01/2016] id: CaO2 el: 0 cu: CCU cg: 140 v1: 13.8058 u1: ml/dl st: NotStopd t0: [21:47:00 18/01/2016] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 98 u1: % rs: Final st: NotStopd
t0: [21:00:00 18/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [21:00:00 18/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [21:00:00 18/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [21:00:00 18/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [21:00:00 18/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [21:00:00 18/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 12 u1: mmHg st: NotStopd t0: [21:00:00 18/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [21:00:00 18/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [21:00:00 18/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [21:00:00 18/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [21:00:00 18/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [21:00:00 18/01/2016] id: Alarms el: 0 cu: CCU cg: RN v1: OFF st: NotStopd t0: [21:00:00 18/01/2016] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [21:00:00 18/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [21:00:00 18/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [21:00:00 18/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Consistently st: NotStopd t0: [21:00:00 18/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [21:00:00 18/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [21:00:00 18/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [21:00:00 18/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding st: NotStopd t0: [21:00:00 18/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [21:00:00 18/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 18/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 18/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [21:00:00 18/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [21:00:00 18/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [21:00:00 18/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [21:00:00 18/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [21:00:00 18/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [21:00:00 18/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 18/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 18/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: CCU cg: RN v1: Soap & H20 st: NotStopd t0: [21:00:00 18/01/2016] id: ImpSkin Character #1 el: 0 cu: CCU cg: RN v1: Abrasion st: NotStopd t0: [21:00:00 18/01/2016] id: ImpSkin Character #2 el: 0 cu: CCU cg: RN v1: Blister st: NotStopd t0: [21:00:00 18/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 18/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 18/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [21:00:00 18/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Open to Air st: NotStopd t0: [21:00:00 18/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: CCU cg: RN v1: Red st: NotStopd t0: [21:00:00 18/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [21:00:00 18/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [21:00:00 18/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [21:00:00 18/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CCU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [21:00:00 18/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 18/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 18/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 18/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [21:00:00 18/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [21:00:00 18/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [21:00:00 18/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 18/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Bronchial st: NotStopd t0: [21:00:00 18/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [21:00:00 18/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 18/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [21:00:00 18/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 18/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 18/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [21:00:00 18/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [21:00:00 18/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 18/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [21:00:00 18/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 18/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 18/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [21:00:00 18/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [21:00:00 18/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [21:00:00 18/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [21:00:00 18/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [21:00:00 18/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [21:00:00 18/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 18/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [21:00:00 18/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [21:00:00 18/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [21:00:00 18/01/2016] id: Stool Color/Consist el: 0 cu: CCU cg: RN v1: Golden v2: Loose st: NotStopd t0: [21:00:00 18/01/2016] id: Stool Guaiac el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [21:00:00 18/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Rectal st: NotStopd t0: [21:00:00 18/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [21:00:00 18/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [21:00:00 18/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Logroll st: NotStopd t0: [21:00:00 18/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [21:00:00 18/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 18/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 18/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [21:00:00 18/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [21:00:00 18/01/2016] id: Braden Activity el: 0 cu: CCU cg: RN v1: Bedfast st: NotStopd t0: [21:00:00 18/01/2016] id: Braden Frict/Shear el: 0 cu: CCU cg: RN v1: Problem st: NotStopd t0: [21:00:00 18/01/2016] id: Braden Mobility el: 0 cu: CCU cg: RN v1: Comp. Immobile st: NotStopd t0: [21:00:00 18/01/2016] id: Braden Moisture el: 0 cu: CCU cg: RN v1: Occ. Moist st: NotStopd t0: [21:00:00 18/01/2016] id: Braden Nutrition el: 0 cu: CCU cg: RN v1: Very Poor st: NotStopd t0: [21:00:00 18/01/2016] id: Braden Score el: 0 cu: CCU cg: RN v1: 8 u1: number st: NotStopd t0: [21:00:00 18/01/2016] id: Braden SensoryPercep el: 0 cu: CCU cg: RN v1: Comp. Limited st: NotStopd t0: [21:00:00 18/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [21:00:00 18/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [21:00:00 18/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [21:00:00 18/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [21:00:00 18/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [21:00:00 18/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [21:00:00 18/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Straw st: NotStopd t0: [21:47:00 18/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: RN rs: Manual st: NotStopd t0: [21:47:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 135 rs: Manual st: NotStopd t0: [21:47:00 18/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: RN rs: Manual st: NotStopd t0: [22:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [22:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [22:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [22:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [22:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 140 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [22:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [22:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [22:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [22:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 6 u1: BPM st: NotStopd t0: [22:00:00 18/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 130 rs: Manual st: NotStopd
t0: [22:00:00 18/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 105 vu: ml t0: [22:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [22:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [22:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [22:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [22:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [22:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 18/01/2016] dt: 24 id: Stool Out Total el: 1 cu: CCU cg: RN cv: 0 ap: carryForward
t0: [23:00:00 18/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [23:00:00 18/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 18/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [23:00:00 18/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 18/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [23:00:00 18/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [23:00:00 18/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 18/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 144 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [23:00:00 18/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [23:00:00 18/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [23:00:00 18/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [23:00:00 18/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 1 u1: BPM st: NotStopd t0: [23:00:00 18/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 18/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 18/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [23:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [23:00:00 18/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [23:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [23:00:00 18/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml
t0: [23:00:00 18/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 18/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 18/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 18/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWkr v1: 148 rs: Manual st: NotStopd
t0: [00:00:00 19/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [00:00:00 19/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 19/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [00:00:00 19/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [00:00:00 19/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 19/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 19/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35.5 u1: Deg. C st: NotStopd t0: [00:00:00 19/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 19/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [00:00:00 19/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 19/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 19/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.5 u1: L/min st: NotStopd t0: [00:00:00 19/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 19/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 19/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [00:00:00 19/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [00:00:00 19/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [00:00:00 19/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [00:00:00 19/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:00:00 19/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [00:00:00 19/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:2.8 st: NotStopd t0: [00:00:00 19/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [00:00:00 19/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [00:00:00 19/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [00:00:00 19/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [00:00:00 19/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [00:00:00 19/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 19/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 19/01/2016] id: Sputum Color/Consist el: 0 cu: CCU cg: RRT v1: White v2: Thick st: NotStopd t0: [00:00:00 19/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
t0: [23:00:00 18/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Not Done st: NotStopd t0: [23:00:00 18/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [23:00:00 18/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [23:00:00 18/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [23:00:00 18/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [23:00:00 18/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [23:00:00 18/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [23:00:00 18/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Not Done st: NotStopd t0: [23:00:00 18/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [23:00:00 18/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Not Done st: NotStopd t0: [23:00:00 18/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [23:00:00 18/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [23:00:00 18/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [23:00:00 18/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [00:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [00:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 136 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [00:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [00:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [00:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 13 u1: BPM st: NotStopd t0: [00:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:15:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [00:15:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:15:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:15:00 19/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:15:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [00:15:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [00:15:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [00:15:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 182 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [00:15:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 125 u1: mmHg st: NotStopd t0: [00:15:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:15:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [00:15:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 38 u1: BPM st: NotStopd t0: [00:15:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [00:15:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:30:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [00:30:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [00:30:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [00:30:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 72 u1: BPM st: NotStopd t0: [00:30:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 133 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [00:30:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [00:30:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [00:30:00 19/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [00:30:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [00:30:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 8 u1: BPM st: NotStopd t0: [00:30:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [00:30:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:45:00 19/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [01:00:00 19/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [01:00:00 19/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [01:00:00 19/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [01:00:00 19/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: No st: NotStopd t0: [01:00:00 19/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [01:00:00 19/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [01:00:00 19/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Grimace Scale st: NotStopd t0: [01:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [01:00:00 19/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [01:00:00 19/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [01:00:00 19/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [01:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 19/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 19/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: No/Not Sedated st: NotStopd t0: [01:00:00 19/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [01:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:00:00 19/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [01:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 19/01/2016] id: Alarms el: 0 cu: CCU cg: RN v1: OFF st: NotStopd t0: [01:00:00 19/01/2016] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [01:00:00 19/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [01:00:00 19/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [01:00:00 19/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [01:00:00 19/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [01:00:00 19/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [01:00:00 19/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [01:00:00 19/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [01:00:00 19/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [01:00:00 19/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 73 u1: BPM st: NotStopd t0: [01:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 19/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 19/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [01:00:00 19/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [01:00:00 19/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [01:00:00 19/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [01:00:00 19/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [01:00:00 19/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm st: NotStopd t0: [01:00:00 19/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 19/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [01:00:00 19/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [01:00:00 19/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Open to Air st: NotStopd t0: [01:00:00 19/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [01:00:00 19/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [01:00:00 19/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [01:00:00 19/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CCU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [01:00:00 19/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 19/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 19/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 19/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [01:00:00 19/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [01:00:00 19/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [01:00:00 19/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Bronchial st: NotStopd t0: [01:00:00 19/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Bronchial st: NotStopd t0: [01:00:00 19/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [01:00:00 19/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [01:00:00 19/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [01:00:00 19/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 19/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [01:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 129 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [01:00:00 19/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [01:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [01:00:00 19/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 19/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [01:00:00 19/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [01:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [01:00:00 19/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [01:00:00 19/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [01:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [01:00:00 19/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 19/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 19/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [01:00:00 19/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [01:00:00 19/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [01:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 14 u1: BPM st: NotStopd t0: [01:00:00 19/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [01:00:00 19/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [01:00:00 19/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [01:00:00 19/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [01:00:00 19/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [01:00:00 19/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [01:00:00 19/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [01:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 19/01/2016] id: Stool Color/Consist el: 0 cu: CCU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [01:00:00 19/01/2016] id: Stool Guaiac el: 0 cu: CCU cg: RN v1: Negative st: NotStopd t0: [01:00:00 19/01/2016] id: Stool Management el: 0 cu: CCU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [01:00:00 19/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [01:00:00 19/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.5 u1: Deg. C st: NotStopd t0: [01:00:00 19/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.7 u1: Deg. F st: NotStopd t0: [01:00:00 19/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 19/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Light Yellow v2: Clear st: NotStopd t0: [01:00:00 19/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 19/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [01:00:00 19/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [01:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 140 rs: Manual st: NotStopd t0: [01:00:00 19/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [01:00:00 19/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [01:00:00 19/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [01:00:00 19/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [01:00:00 19/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Not Applicable st: NotStopd t0: [01:00:00 19/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [01:00:00 19/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [01:00:00 19/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [00:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [00:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [00:00:00 19/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml t0: [00:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 2.5 vu: ml t0: [00:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.5 vu: ml t0: [01:00:00 19/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 120 vu: ml t0: [01:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [01:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [01:00:00 19/01/2016] tf: [18:30:00 19/01/2016] dt: 1050 id: Free Water Bolus PO/Gastric el: 1 cu: CCU cg: RN ai: 274 vo: 250 vu: ml t0: [01:00:00 19/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 40 vu: ml st: Stopped t0: [01:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [01:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3.25 vu: ml
t0: [00:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 125 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [00:15:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:15:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:15:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [00:30:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:30:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:30:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [01:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 19/01/2016] dt: 24 id: PO/Gastric In Total el: 1 cu: -1 cg: RN cv: 550 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: Stool Out Total el: 1 cu: -1 cg: RN cv: 0 ap: carryForward t0: [23:00:00 19/01/2016] dt: 24 id: Tube Feeds In Total el: 1 cu: -1 cg: RN cv: 160 ap: none
t0: [02:00:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWkr v1: 148 rs: Manual st: NotStopd
t0: [03:00:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWkr v1: 137 rs: Manual st: NotStopd
t0: [02:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [02:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [02:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [02:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 70 u1: BPM st: NotStopd t0: [02:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 129 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [02:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [02:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [02:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [02:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 18 u1: BPM st: NotStopd t0: [02:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [03:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [03:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [03:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [03:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 125 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [03:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [03:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [03:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [03:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 16 u1: BPM st: NotStopd t0: [03:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [02:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [02:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [02:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml t0: [03:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [03:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [03:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [03:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 4 vu: ml
t0: [02:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [03:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 19/01/2016] dt: 24 id: IV Infusion In Total el: 1 cu: -1 cg: RN cv: 1671.08 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: IV Nutrition Total el: 1 cu: -1 cg: RN cv: 991.1 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: 24h Total In el: 1 cu: -1 cg: RN cv: 3372.18 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: Urine Out Total el: 1 cu: -1 cg: RN cv: 2760 ap: none
t0: [01:00:00 19/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 11 u1: mmHg st: NotStopd
t0: [23:00:00 19/01/2016] dt: 1 id: Total Hourly Output el: 1 cu: -1 cg: RN cv: 0 ap: none t0: [23:00:00 19/01/2016] dt: 1 id: Net Hourly Balance el: 1 cu: -1 cg: RN cv: 0 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: 24h Net Body Balance el: 1 cu: -1 cg: RN cv: 587.183 ap: carryForward t0: [23:00:00 19/01/2016] dt: 24 id: 24h Total Out el: 1 cu: -1 cg: RN cv: 2785 ap: carryForward t0: [23:00:00 19/01/2016] dt: 24 id: Chest Tube Out Total el: 1 cu: -1 cg: RN cv: 25 ap: none t0: [23:00:00 19/01/2016] dt: multiple days id: LOS Net Body Balance el: 1 cu: -1 cg: RN cv: 14715.4 ap: carryForward
t0: [03:29:00 19/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.36 rs: Final st: NotStopd t0: [03:29:00 19/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 3 rs: Final st: NotStopd t0: [03:29:00 19/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 32 rs: Final st: NotStopd t0: [03:29:00 19/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 54 u1: mmHg rs: Final st: NotStopd t0: [03:29:00 19/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 173 u1: mmHg rs: Final st: NotStopd t0: [03:29:00 19/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.36 rs: Final st: NotStopd t0: [03:29:00 19/01/2016] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 98 u1: % rs: Final st: NotStopd
t0: [03:00:00 19/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 17.9 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 17.9 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 33.4 u1: % rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 9.9 u1: gm/dl rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 536 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 3.5 u1: /mic l rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 17.9 rs: Final st: NotStopd t0: [03:29:00 19/01/2016] id: CaO2 el: 0 cu: CCU cg: 140 v1: 13.537 u1: ml/dl st: NotStopd
t0: [03:00:00 19/01/2016] id: BUN el: 0 cu: CCU cg: 140 v1: 71 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: PT el: 0 cu: CCU cg: 140 v1: 13.5 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Calcium Chemistry el: 0 cu: CCU cg: 140 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 109 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 127 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: INR Coags el: 0 cu: CCU cg: 140 v1: 1.2 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Magnesium Chemistry el: 0 cu: CCU cg: 140 v1: 1.8 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: PTT Coags el: 0 cu: CCU cg: 140 v1: 29.3 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Phosphorous Chemistry el: 0 cu: CCU cg: 140 v1: 2.4 u1: mEq/L rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 3.3 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 146 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 71 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: CCU cg: 140 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 28 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 109 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 127 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: CCU cg: 140 v1: 1.2 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: CCU cg: 140 v1: 1.8 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: PT(11-13.5) Coags el: 0 cu: CCU cg: 140 v1: 13.5 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: PTT(22-35) Coags el: 0 cu: CCU cg: 140 v1: 29.3 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: CCU cg: 140 v1: 2.4 u1: mEq/L rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 3.3 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 146 rs: Final st: NotStopd
t0: [03:00:00 19/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Not Done st: NotStopd t0: [03:00:00 19/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [03:00:00 19/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Not Done st: NotStopd t0: [03:00:00 19/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [03:00:00 19/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Not Done st: NotStopd t0: [03:00:00 19/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [03:00:00 19/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [03:00:00 19/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [03:00:00 19/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [04:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [04:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [04:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 69 u1: BPM st: NotStopd t0: [04:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 127 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [04:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [04:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [04:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [04:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 22 u1: BPM st: NotStopd t0: [04:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [04:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [04:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [04:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [04:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [03:00:00 19/01/2016] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 1.4 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 1.4 rs: Final st: NotStopd
t0: [04:00:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 108 rs: Manual st: NotStopd
t0: [04:50:00 19/01/2016] id: RSBI Not Completed el: 0 cu: CCU cg: RRT v1: Other/Remarks st: NotStopd t0: [04:50:00 19/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [04:50:00 19/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:50:00 19/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:50:00 19/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [04:50:00 19/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:50:00 19/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [04:50:00 19/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 35.5 u1: Deg. C st: NotStopd t0: [04:50:00 19/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:50:00 19/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [04:50:00 19/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:50:00 19/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:50:00 19/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [04:50:00 19/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:50:00 19/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [04:50:00 19/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [04:50:00 19/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [04:50:00 19/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [04:50:00 19/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [04:50:00 19/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:50:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 99 u1: % st: NotStopd t0: [04:50:00 19/01/2016] id: TCPCV Fixed I Time el: 0 cu: CCU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [04:50:00 19/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:2.8 st: NotStopd t0: [04:50:00 19/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [04:50:00 19/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [04:50:00 19/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 11 st: NotStopd t0: [04:50:00 19/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [04:50:00 19/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [04:50:00 19/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [04:50:00 19/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [05:00:00 19/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 19/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [05:00:00 19/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [05:00:00 19/01/2016] id: Pain Present el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 19/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 19/01/2016] id: Pain Assess Method el: 0 cu: CCU cg: RN v1: Change in Vitals st: NotStopd t0: [05:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [05:00:00 19/01/2016] id: CVP el: 0 cu: CCU cg: RN v1: 10 u1: mmHg st: NotStopd t0: [05:00:00 19/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [05:00:00 19/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [05:00:00 19/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [05:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 19/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Agitated st: NotStopd t0: [05:00:00 19/01/2016] id: Daily Wake Up el: 1 cu: CCU cg: RN v1: No/Not Sedated st: NotStopd t0: [05:00:00 19/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [05:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 19/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [05:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 19/01/2016] id: Alarms el: 0 cu: CCU cg: RN v1: OFF st: NotStopd t0: [05:00:00 19/01/2016] id: Parameters Checked el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [05:00:00 19/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [05:00:00 19/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [05:00:00 19/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [05:00:00 19/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 10 u1: points st: NotStopd t0: [05:00:00 19/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [05:00:00 19/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [05:00:00 19/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [05:00:00 19/01/2016] id: HOB el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [05:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 19/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 19/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [05:00:00 19/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 19/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [05:00:00 19/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right Subclavian st: NotStopd t0: [05:00:00 19/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 1 st: NotStopd t0: [05:00:00 19/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Soft Distended st: NotStopd t0: [05:00:00 19/01/2016] id: Activity el: 0 cu: CCU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 19/01/2016] id: Activity Tolerance el: 0 cu: CCU cg: RN v1: Tolerated Well st: NotStopd t0: [05:00:00 19/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [05:00:00 19/01/2016] id: ImpSkin Treatment #2 el: 0 cu: CCU cg: RN v1: Open to Air st: NotStopd t0: [05:00:00 19/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [05:00:00 19/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [05:00:00 19/01/2016] id: Inc Closure/Appear#1 el: 0 cu: CCU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [05:00:00 19/01/2016] id: Inc Closure/Appear#2 el: 0 cu: CCU cg: RN v1: Approximated v2: Granulating st: NotStopd t0: [05:00:00 19/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 19/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 19/01/2016] id: Inc Dsg/Status #1 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 19/01/2016] id: Inc Dsg/Status #2 el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [05:00:00 19/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [05:00:00 19/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [05:00:00 19/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [05:00:00 19/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [05:00:00 19/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [05:00:00 19/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [05:00:00 19/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [05:00:00 19/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 19/01/2016] id: AntiEmbDevice/Status el: 0 cu: CCU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 133 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [05:00:00 19/01/2016] id: Pain Location el: 0 cu: CCU cg: RN v1: Not Indicated st: NotStopd t0: [05:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [05:00:00 19/01/2016] id: Position el: 0 cu: CCU cg: RN v1: Supine st: NotStopd t0: [05:00:00 19/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/01/2016] id: Assistance Device el: 0 cu: CCU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [05:00:00 19/01/2016] id: PressureReduceDevice el: 0 cu: CCU cg: RN v1: Waffles st: NotStopd t0: [05:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [05:00:00 19/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [05:00:00 19/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [05:00:00 19/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [05:00:00 19/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [05:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 40 u1: BPM st: NotStopd t0: [05:00:00 19/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [05:00:00 19/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [05:00:00 19/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [05:00:00 19/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [05:00:00 19/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [05:00:00 19/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [05:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [05:00:00 19/01/2016] id: Stool Management el: 0 cu: CCU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [05:00:00 19/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [05:00:00 19/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [05:00:00 19/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [05:00:00 19/01/2016] id: Turn el: 0 cu: CCU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 19/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [05:00:00 19/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 19/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [05:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 19/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [05:00:00 19/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [05:00:00 19/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [05:00:00 19/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [05:00:00 19/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [05:00:00 19/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: H2O Seal st: NotStopd t0: [05:00:00 19/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [05:00:00 19/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [05:05:00 19/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [05:10:00 19/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [05:15:00 19/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [05:20:00 19/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd
t0: [05:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [05:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1.58333 vu: ml t0: [05:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3.5 vu: ml t0: [05:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 2.25 vu: ml
t0: [03:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip t0: [04:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip t0: [05:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [05:00:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 106 rs: Manual st: NotStopd
t0: [06:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [06:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [06:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 4 vu: ml t0: [06:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 5 vu: ml
io: Carrier 100.0ml IV Infusions el: 1 cu: CCU cg: RN ra: 10 ru: ml/hr
id: Carrier el: 1 cu: CCU cg: RN io: Carrier 100.0ml IV Infusions vo: 100 du: ml rt: Intravenous Push
t0: [06:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [06:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [06:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [06:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 68 u1: BPM st: NotStopd t0: [06:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 117 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [06:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [06:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [06:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [06:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 21 u1: BPM st: NotStopd t0: [06:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: RN v1: 117 rs: Manual st: NotStopd
t0: [06:00:00 19/01/2016] id: Carrier 100.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 111 vo: 0 vu: ml nb: 1
t0: [06:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [08:00:00 19/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 19/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 19/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 19/01/2016] id: Range of Motion el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [08:00:00 19/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 19/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 19/01/2016] id: Circulation/SkinInt el: 0 cu: CCU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 19/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 19/01/2016] id: GI Prophylaxis el: 0 cu: CCU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [08:00:00 19/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [08:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [08:00:00 19/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 19/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 2 To pain st: NotStopd t0: [08:00:00 19/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [08:00:00 19/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 7 u1: points st: NotStopd t0: [08:00:00 19/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 19/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 19/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [08:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 19/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 19/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 19/01/2016] id: ImpSkin Treatment #1 el: 0 cu: CCU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 19/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 19/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [08:00:00 19/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 19/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 19/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 19/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [08:00:00 19/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 19/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [08:00:00 19/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 19/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 116 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [08:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [08:00:00 19/01/2016] id: Position Change el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [08:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [08:00:00 19/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 19/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [08:00:00 19/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 19/01/2016] id: Removed x 5 Mins el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [08:00:00 19/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [08:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 22 u1: BPM st: NotStopd t0: [08:00:00 19/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: Both Arms st: NotStopd t0: [08:00:00 19/01/2016] id: Restraint Type el: 0 cu: CCU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 19/01/2016] id: Restraints Evaluated el: 0 cu: CCU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 19/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 19/01/2016] id: Skin Integrity el: 0 cu: CCU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 19/01/2016] id: Skin Temp/Condition el: 0 cu: CCU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 19/01/2016] id: Stool Management el: 0 cu: CCU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [08:00:00 19/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 19/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 19/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 19/01/2016] id: Behavior el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 19/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [08:00:00 19/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [08:00:00 19/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [08:00:00 19/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 19/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 19/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [08:00:00 19/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [08:00:00 19/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [08:00:00 19/01/2016] tf: [14:00:00 19/01/2016] dt: 360 id: Carrier 100.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 111 vo: 20 vu: ml t0: [08:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [08:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [08:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 8 vu: ml t0: [08:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 10 vu: ml
t0: [08:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 200 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [08:00:00 19/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [08:00:00 19/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 19/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:00:00 19/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [08:00:00 19/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 19/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 19/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 34.6 u1: Deg. C st: NotStopd t0: [08:00:00 19/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 19/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [08:00:00 19/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 19/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 19/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [08:00:00 19/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 19/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 19/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [08:00:00 19/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [08:00:00 19/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [08:00:00 19/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [08:00:00 19/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 19/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:2.8 st: NotStopd t0: [08:00:00 19/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [08:00:00 19/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [08:00:00 19/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [08:00:00 19/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 314 u1: ml/B st: NotStopd t0: [08:00:00 19/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [08:00:00 19/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 19/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 124 rs: Manual st: NotStopd
t0: [09:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [09:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [09:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 67 u1: BPM st: NotStopd t0: [09:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 133 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [09:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [09:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [09:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 71.7 u1: kg st: NotStopd t0: [09:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 19 u1: BPM st: NotStopd t0: [09:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 19/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [09:00:00 19/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [09:00:00 19/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.6 u1: Deg. F st: NotStopd t0: [09:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [10:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [10:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [10:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [10:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 62 u1: BPM st: NotStopd t0: [10:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 126 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [10:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [10:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [10:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 24 u1: BPM st: NotStopd t0: [10:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 19/01/2016] id: Carrier 100.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 111 vo: 20 vu: ml t0: [10:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [10:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [10:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [10:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 7 vu: ml t0: [10:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 8 vu: ml
t0: [10:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [10:30:00 19/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [10:30:00 19/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [10:30:00 19/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [10:30:00 19/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [10:30:00 19/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 270 u1: ml/B st: NotStopd
t0: [10:00:00 19/01/2016] id: Previous Weight el: 0 cu: CCU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [10:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [10:00:00 19/01/2016] id: BSA - English el: 0 cu: CCU cg: RN v1: 1.14431 u1: m2 st: NotStopd t0: [10:00:00 19/01/2016] id: BSA - Metric el: 0 cu: CCU cg: RN v1: 1.33769 u1: m2 st: NotStopd t0: [10:00:00 19/01/2016] id: Weight Change el: 0 cu: CCU cg: RN v1: 0 u1: kg st: NotStopd t0: [10:00:00 19/01/2016] id: Daily Weight el: 0 cu: CCU cg: RN v1: 70.2 u1: kg st: NotStopd
tf: [10:00:00 20/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 11 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [10:00:00 20/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [11:30:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 137 rs: Manual st: NotStopd
t0: [11:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [11:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 19/01/2016] id: Riker-SAS Scale el: 0 cu: CCU cg: RN v1: Sedated st: NotStopd t0: [11:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [11:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 65 u1: BPM st: NotStopd t0: [11:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 139 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [11:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [11:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [11:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [11:00:00 19/01/2016] id: Procedures el: 0 cu: CCU cg: RN v1: Line Placement st: NotStopd t0: [11:00:00 19/01/2016] id: Radiologic Study el: 0 cu: CCU cg: RN v1: Chest Xray st: NotStopd t0: [11:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 24 u1: BPM st: NotStopd t0: [11:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [12:00:00 19/01/2016] id: INV#2Chg o/Wire Date el: 0 cu: CCU cg: -1 st: D/C'd t0: [12:00:00 19/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [12:00:00 19/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 19/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [12:00:00 19/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [12:00:00 19/01/2016] id: INV Line#2 Site Date el: 0 cu: CCU cg: -1 st: D/C'd t0: [12:00:00 19/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 19/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 19/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 34.6 u1: Deg. C st: NotStopd t0: [12:00:00 19/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 19/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [12:00:00 19/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 19/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 19/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [12:00:00 19/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 19/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 19/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [12:00:00 19/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [12:00:00 19/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:00:00 19/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [12:00:00 19/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:00:00 19/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:2.8 st: NotStopd t0: [12:00:00 19/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [12:00:00 19/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [12:00:00 19/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [12:00:00 19/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 270 u1: ml/B st: NotStopd t0: [12:00:00 19/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [12:00:00 19/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 19/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
io: D5W IV Infusions el: 1 cu: CCU cg: RN ra: 150 ru: ml/hr
pt: TPN tf: [10:00:00 21/01/2016] pt: IV Piggyback rt: IV fr: Q12H fs: 12, 0 dn: 2 m1: Cefepime v1: 2 u1: gm m2: D5W v2: 100 u2: ml
id: D5W el: 1 cu: CCU cg: RN io: D5W IV Infusions du: ml rt: Intravenous Push
t0: [12:00:00 19/01/2016] id: Sputum Source/Amt el: 0 cu: CCU cg: RRT v1: Suctioned v2: None st: NotStopd
t0: [12:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [12:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [12:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [12:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 62 u1: BPM st: NotStopd t0: [12:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 19/01/2016] id: INV Line#1 Type/Site el: 0 cu: CCU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 19/01/2016] id: INV Line#1InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 19/01/2016] id: INV Line#2 Type/Site el: 0 cu: CCU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [12:00:00 19/01/2016] id: INV Line#2InsertDate el: 0 cu: CCU cg: RN v1: 1 v2: 20 st: NotStopd t0: [12:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 136 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [12:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [12:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [12:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [12:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 24 u1: BPM st: NotStopd t0: [12:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 19/01/2016] id: Carrier 100.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 111 vo: 20 vu: ml t0: [12:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [12:00:00 19/01/2016] id: D5W IV Infusions el: 1 cu: CCU cg: RN ai: 168 vo: 0 vu: ml nb: 1 t0: [12:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [12:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 2 vu: ml t0: [12:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 6 vu: ml t0: [12:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 6 vu: ml
t0: [12:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:39:00 19/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.34 rs: Final st: NotStopd t0: [12:39:00 19/01/2016] id: Lactic Acid Chemistry el: 0 cu: CCU cg: 140 v1: 1 rs: Final st: NotStopd t0: [12:39:00 19/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 4 rs: Final st: NotStopd t0: [12:39:00 19/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 33 rs: Final st: NotStopd t0: [12:39:00 19/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 58 u1: mmHg rs: Final st: NotStopd t0: [12:39:00 19/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 174 u1: mmHg rs: Final st: NotStopd t0: [12:39:00 19/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.34 rs: Final st: NotStopd t0: [12:39:00 19/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: CCU cg: 140 v1: 1 rs: Final st: NotStopd
t0: [13:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [13:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [13:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [13:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 62 u1: BPM st: NotStopd t0: [13:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 140 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [13:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [13:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [13:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [13:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 36 u1: BPM st: NotStopd t0: [13:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml nb: 1 t0: [13:00:00 19/01/2016] tf: [18:30:00 19/01/2016] dt: 330 id: D5W IV Infusions el: 1 cu: CCU cg: RN ai: 168 vo: 150 vu: ml t0: [13:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [13:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [13:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [13:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:00:00 19/01/2016] id: Albumin Chemistry el: 0 cu: CCU cg: 140 v1: 2.6 rs: Final st: NotStopd t0: [03:00:00 19/01/2016] id: Albumin (>3.2) Chemistry el: 0 cu: CCU cg: 140 v1: 2.6 rs: Final st: NotStopd
t0: [13:30:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 149 rs: Manual st: NotStopd
t0: [14:00:00 19/01/2016] id: Carrier 100.0ml IV Infusions el: 1 cu: CCU cg: -1 ai: 111 vo: 0 st: D/C'd
t0: [10:00:00 19/01/2016] id: Eye Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 19/01/2016] id: Oral Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 19/01/2016] id: Skin Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [10:00:00 19/01/2016] id: Back Care el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [11:00:00 19/01/2016] id: Edema Location/Amt#1 el: 0 cu: CCU cg: RN v1: General v2: Anasarca st: NotStopd t0: [11:00:00 19/01/2016] id: Impaired Skin Site#1 el: 0 cu: CCU cg: RN v1: Coccyx st: NotStopd t0: [11:00:00 19/01/2016] id: Impaired Skin Site#2 el: 0 cu: CCU cg: RN v1: Chest st: NotStopd t0: [11:00:00 19/01/2016] id: Incision/Wound #1 el: 0 cu: CCU cg: RN v1: Sternum st: NotStopd t0: [11:00:00 19/01/2016] id: Incision/Wound #2 el: 0 cu: CCU cg: RN v1: Mediastinal st: NotStopd t0: [11:00:00 19/01/2016] id: Reason For Restraint el: 0 cu: CCU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [11:00:00 19/01/2016] id: Restraint Location el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [11:00:00 19/01/2016] id: Side Rails el: 0 cu: CCU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 19/01/2016] id: CT #2 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 19/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 19/01/2016] id: CT #2 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [14:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [14:00:00 19/01/2016] id: Chest Tube Site #1 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 19/01/2016] id: Chest Tube Site #2 el: 0 cu: CCU cg: RN v1: Left Anterior st: NotStopd t0: [14:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [14:00:00 19/01/2016] id: Diet Type el: 0 cu: CCU cg: RN v1: TPN st: NotStopd t0: [14:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [14:00:00 19/01/2016] id: Eye Opening el: 0 cu: CCU cg: RN v1: 3 To speech st: NotStopd t0: [14:00:00 19/01/2016] id: Follows Commands el: 0 cu: CCU cg: RN v1: Inconsistently st: NotStopd t0: [14:00:00 19/01/2016] id: GCS Total el: 0 cu: CCU cg: RN v1: 9 u1: points st: NotStopd t0: [14:00:00 19/01/2016] id: GI Intub #2/Site el: 0 cu: CCU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [14:00:00 19/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: CCU cg: RN v1: Done st: NotStopd t0: [14:00:00 19/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: CCU cg: RN v1: Feeding v2: Bilious st: NotStopd t0: [14:00:00 19/01/2016] id: GU Cath Insert Date el: 0 cu: CCU cg: RN v1: 12 v2: 29 st: NotStopd t0: [14:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 61 u1: BPM st: NotStopd t0: [14:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 19/01/2016] id: Height of Bed el: 0 cu: CCU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 19/01/2016] id: Abdominal Assessment el: 0 cu: CCU cg: RN v1: Firm Distended st: NotStopd t0: [14:00:00 19/01/2016] id: LLL Lung Sounds el: 0 cu: CCU cg: RN v1: Diminished st: NotStopd t0: [14:00:00 19/01/2016] id: LUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [14:00:00 19/01/2016] id: Level of Conscious el: 0 cu: CCU cg: RN v1: Arouse to Voice st: NotStopd t0: [14:00:00 19/01/2016] id: Motor Response el: 0 cu: CCU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [14:00:00 19/01/2016] id: Oral Cavity el: 0 cu: CCU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [14:00:00 19/01/2016] id: Orientation el: 0 cu: CCU cg: RN v1: Other/Remarks st: NotStopd t0: [14:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 145 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [14:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [14:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [14:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [14:00:00 19/01/2016] id: RLL Lung Sounds el: 0 cu: CCU cg: RN v1: Coarse st: NotStopd t0: [14:00:00 19/01/2016] id: RUL Lung Sounds el: 0 cu: CCU cg: RN v1: Clear st: NotStopd t0: [14:00:00 19/01/2016] id: Respiratory Pattern el: 0 cu: CCU cg: RN v1: Regular st: NotStopd t0: [14:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 38 u1: BPM st: NotStopd t0: [14:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 19/01/2016] id: Stool Management el: 0 cu: CCU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [14:00:00 19/01/2016] id: Urine Color/Appear el: 0 cu: CCU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [14:00:00 19/01/2016] id: Urine Source el: 0 cu: CCU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 19/01/2016] id: Verbal Response el: 0 cu: CCU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [14:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 19/01/2016] id: Bowel Sounds el: 0 cu: CCU cg: RN v1: Present st: NotStopd t0: [14:00:00 19/01/2016] id: CT #1 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [14:00:00 19/01/2016] id: CT #1 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd t0: [14:00:00 19/01/2016] id: CT #1 Dressing el: 0 cu: CCU cg: RN v1: Dry and Intact st: NotStopd t0: [14:00:00 19/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: CCU cg: RN v1: Positive v2: Negative st: NotStopd t0: [14:00:00 19/01/2016] id: CT #1 Suction Amount el: 0 cu: CCU cg: RN v1: 20 cm st: NotStopd t0: [14:00:00 19/01/2016] id: CT #2 Crepitus el: 0 cu: CCU cg: RN v1: Positive st: NotStopd t0: [14:00:00 19/01/2016] id: CT #2 Drainage el: 0 cu: CCU cg: RN v1: Serosanguinous st: NotStopd
t0: [13:00:00 19/01/2016] id: Carrier 100.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 111 vu: ml t0: [13:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml nb: 1 t0: [14:00:00 19/01/2016] id: TF Residual Gastric/TF Residual el: 1 cu: CCU cg: RN ai: 128 vo: 25 vu: ml t0: [14:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 19/01/2016] id: D5W IV Infusions el: 1 cu: CCU cg: RN ai: 168 vo: 150 vu: ml t0: [14:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 58.3 vu: ml t0: [14:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 1 vu: ml t0: [14:00:00 19/01/2016] id: Free Water Bolus PO/Gastric el: 1 cu: CCU cg: RN ai: 274 vo: 250 vu: ml t0: [14:00:00 19/01/2016] id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 0 vu: ml nb: 1 t0: [14:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 3 vu: ml t0: [14:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 3 vu: ml
t0: [14:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [14:59:00 19/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.33 rs: Final st: NotStopd t0: [14:59:00 19/01/2016] id: CaO2 el: 0 cu: CCU cg: 140 v1: 13.3981 u1: ml/dl st: NotStopd t0: [14:59:00 19/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 154 rs: Final st: NotStopd t0: [14:59:00 19/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [14:59:00 19/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 31 rs: Final st: NotStopd t0: [14:59:00 19/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 57 u1: mmHg rs: Final st: NotStopd t0: [14:59:00 19/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 171 u1: mmHg rs: Final st: NotStopd t0: [14:59:00 19/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.33 rs: Final st: NotStopd t0: [14:59:00 19/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 154 rs: Final st: NotStopd t0: [14:59:00 19/01/2016] id: SaO2 ABG's el: 0 cu: CCU cg: 140 v1: 97 u1: % rs: Final st: NotStopd
t0: [14:00:00 19/01/2016] id: Temp. Site el: 0 cu: CCU cg: RN v1: Oral st: NotStopd t0: [14:00:00 19/01/2016] id: Temperature C (calc) el: 0 cu: CCU cg: RN v1: 36.1667 u1: Deg. C st: NotStopd t0: [14:00:00 19/01/2016] id: Temperature F el: 0 cu: CCU cg: RN v1: 97.1 u1: Deg. F st: NotStopd t0: [15:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [15:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [15:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [15:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 63 u1: BPM st: NotStopd t0: [15:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 139 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [15:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [15:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [15:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [15:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 40 u1: BPM st: NotStopd t0: [15:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:30:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [13:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [14:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip t0: [15:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [16:00:00 19/01/2016] id: Service Type el: 0 cu: CCU cg: RN v1: MICU st: NotStopd t0: [16:00:00 19/01/2016] id: Code Status el: 0 cu: CCU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 19/01/2016] id: Risk for Falls el: 0 cu: CCU cg: RN v1: Yes st: NotStopd t0: [16:00:00 19/01/2016] id: Ectopy Type el: 0 cu: CCU cg: RN v1: None st: NotStopd t0: [16:00:00 19/01/2016] id: Heart Rate el: 0 cu: CCU cg: RN v1: 62 u1: BPM st: NotStopd t0: [16:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: CCU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 19/01/2016] id: Arterial BP el: 0 cu: CCU cg: RN v1: 150 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [16:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: CCU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [16:00:00 19/01/2016] id: Precautions el: 0 cu: CCU cg: RN v1: Universal st: NotStopd t0: [16:00:00 19/01/2016] id: Previous WeightF el: 0 cu: CCU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [16:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: CCU cg: RN v1: 32 u1: BPM st: NotStopd t0: [16:00:00 19/01/2016] id: calprevflg el: 0 cu: CCU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 19/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: 107 vo: 20 vu: ml t0: [16:00:00 19/01/2016] id: D5W IV Infusions el: 1 cu: CCU cg: RN ai: 168 vo: 300 vu: ml t0: [16:00:00 19/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: CCU cg: RN ai: -1 vo: 116.6 vu: ml t0: [16:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: CCU cg: RN ai: 209 vo: 4 vu: ml t0: [16:00:00 19/01/2016] tf: [18:30:00 19/01/2016] dt: 150 id: Criticare HN Tube Feeding el: 1 cu: CCU cg: RN ai: 498 vo: 80 vu: ml t0: [16:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: CCU cg: RN ai: 416 vo: 6 vu: ml t0: [16:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: CCU cg: RN ai: 431 vo: 6 vu: ml
t0: [16:00:00 19/01/2016] id: Fentanyl el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 19/01/2016] id: Midazolam el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 19/01/2016] id: Insulin el: 1 cu: CCU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [16:03:00 19/01/2016] id: Art.pH ABG el: 0 cu: CCU cg: 140 v1: 7.33 rs: Final st: NotStopd t0: [16:03:00 19/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 155 rs: Final st: NotStopd t0: [16:03:00 19/01/2016] id: Arterial Base Excess ABG el: 0 cu: CCU cg: 140 v1: 2 rs: Final st: NotStopd t0: [16:03:00 19/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: CCU cg: 140 v1: 31 rs: Final st: NotStopd t0: [16:03:00 19/01/2016] id: Arterial PaCO2 ABG el: 0 cu: CCU cg: 140 v1: 57 u1: mmHg rs: Final st: NotStopd t0: [16:03:00 19/01/2016] id: Arterial PaO2 ABG el: 0 cu: CCU cg: 140 v1: 157 u1: mmHg rs: Final st: NotStopd t0: [16:03:00 19/01/2016] id: Arterial pH ABG el: 0 cu: CCU cg: 140 v1: 7.33 rs: Final st: NotStopd t0: [16:03:00 19/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 155 rs: Final st: NotStopd
t0: [16:05:00 19/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 24.8 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: WBC Hematology el: 0 cu: CCU cg: 140 v1: 24.8 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Hematocrit Hematology el: 0 cu: CCU cg: 140 v1: 33.1 u1: % rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Hemoglobin Hematology el: 0 cu: CCU cg: 140 v1: 10.2 u1: gm/dl rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Platelets Hematology el: 0 cu: CCU cg: 140 v1: 589 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: RBC Hematology el: 0 cu: CCU cg: 140 v1: 3.46 u1: /mic l rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: CCU cg: 140 v1: 24.8 rs: Final st: NotStopd
t0: [17:00:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: CCU cg: CoWker v1: 155 rs: Manual st: NotStopd
t0: [17:00:00 19/01/2016] id: ETT Mark/Location el: 0 cu: CCU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [17:00:00 19/01/2016] id: FiO2 Set el: 0 cu: CCU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 19/01/2016] id: High Insp. Pressure el: 0 cu: CCU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [17:00:00 19/01/2016] id: High Resp. Rate el: 0 cu: CCU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [17:00:00 19/01/2016] id: Airway Size el: 0 cu: CCU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 19/01/2016] id: Airway Type el: 0 cu: CCU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 19/01/2016] id: Inspired Gas Temp el: 0 cu: CCU cg: RRT v1: 34.6 u1: Deg. C st: NotStopd t0: [17:00:00 19/01/2016] id: Intubation Date el: 0 cu: CCU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 19/01/2016] id: Low Exhaled Min Vol el: 0 cu: CCU cg: RRT v1: 7 st: NotStopd t0: [17:00:00 19/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 19/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: CCU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:00:00 19/01/2016] id: Minute Volume(Obser) el: 0 cu: CCU cg: RRT v1: 10.8 u1: L/min st: NotStopd t0: [17:00:00 19/01/2016] id: PEEP Set el: 0 cu: CCU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 19/01/2016] id: Apnea Time Interval el: 0 cu: CCU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 19/01/2016] id: Peak Insp. Pressure el: 0 cu: CCU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [17:00:00 19/01/2016] id: Resp Rate (Spont) el: 0 cu: CCU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [17:00:00 19/01/2016] id: Resp Rate (Total) el: 0 cu: CCU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [17:00:00 19/01/2016] id: Respiratory Rate Set el: 0 cu: CCU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [17:00:00 19/01/2016] id: Sensitivity-Vent el: 0 cu: CCU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [17:00:00 19/01/2016] id: SpO2 el: 0 cu: CCU cg: RRT v1: 100 u1: % st: NotStopd t0: [17:00:00 19/01/2016] id: TCPCV I:E Ratio el: 0 cu: CCU cg: RRT v1: 1:2.8 st: NotStopd t0: [17:00:00 19/01/2016] id: TCPCV Insp. Pressure el: 0 cu: CCU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [17:00:00 19/01/2016] id: TCPCV Insp. Time el: 0 cu: CCU cg: RRT v1: 0.5 u1: sec st: NotStopd t0: [17:00:00 19/01/2016] id: TCPCV-MAP el: 0 cu: CCU cg: RRT v1: 10 st: NotStopd t0: [17:00:00 19/01/2016] id: Tidal Volume (Obser) el: 0 cu: CCU cg: RRT v1: 330 u1: ml/B st: NotStopd t0: [17:00:00 19/01/2016] id: Ventilator Mode el: 0 cu: CCU cg: RRT v1: Pressure Control st: NotStopd t0: [17:00:00 19/01/2016] id: Ventilator Type el: 0 cu: CCU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 19/01/2016] id: Waveform-Vent el: 0 cu: CCU cg: RRT v1: RAMP st: NotStopd
t0: [16:05:00 19/01/2016] id: BUN el: 0 cu: CCU cg: 140 v1: 67 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Chloride Chemistry el: 0 cu: CCU cg: 140 v1: 106 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Creatinine Chemistry el: 0 cu: CCU cg: 140 v1: 1.2 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Glucose Chemistry el: 0 cu: CCU cg: 140 v1: 152 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Potassium Chemistry el: 0 cu: CCU cg: 140 v1: 3.4 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Sodium Chemistry el: 0 cu: CCU cg: 140 v1: 143 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: BUN (6-20) Chemistry el: 0 cu: CCU cg: 140 v1: 67 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: CCU cg: 140 v1: 32 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: CCU cg: 140 v1: 106 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: CCU cg: 140 v1: 1.2 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: CCU cg: 140 v1: 152 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: CCU cg: 140 v1: 3.4 rs: Final st: NotStopd t0: [16:05:00 19/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: CCU cg: 140 v1: 143 rs: Final st: NotStopd
tf: [17:00:00 20/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 18 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml
tf: [17:24:00 26/02/2016] dt: 54652 cu: MICU di: No Disch Status
t0: [19:00:00 19/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 19/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 19/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [19:00:00 19/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 19/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 19/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [19:00:00 19/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 19/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [19:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 19/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [19:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [19:00:00 19/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 19/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [19:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [19:00:00 19/01/2016] id: Significant Events el: 0 cu: MICU cg: RN st: NotStopd t0: [19:00:00 19/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 19/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [19:00:00 19/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.8333 u1: Deg. C st: NotStopd t0: [19:00:00 19/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 96.5 u1: Deg. F st: NotStopd t0: [19:00:00 19/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 19/01/2016] tf: [05:00:00 20/01/2016] dt: 600 id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 300 vu: ml t0: [18:00:00 19/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 80 vu: ml st: Stopped t0: [19:00:00 19/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml t0: [19:00:00 19/01/2016] tf: [20:00:00 21/01/2016] dt: 2940 id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 6 vu: ml t0: [19:00:00 19/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml t0: [19:00:00 19/01/2016] tf: [06:00:00 25/01/2016] dt: 7860 id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 9 vu: ml t0: [19:00:00 19/01/2016] tf: [09:00:00 20/01/2016] dt: 840 id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 9 vu: ml
t0: [19:00:00 19/01/2016] tf: [05:00:00 25/01/2016] dt: 7800 id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 19/01/2016] tf: [16:00:00 23/01/2016] dt: 5580 id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 19/01/2016] tf: [08:00:00 20/01/2016] dt: 780 id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [20:00:00 19/01/2016] id: INV Line#3 D/C Date el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 19/01/2016] id: INV Line#3 Type/Site el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 19/01/2016] id: INV Line#3InsertDate el: 0 cu: MICU cg: -1 st: D/C'd
t0: [20:00:00 19/01/2016] id: CT #2 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 19/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 19/01/2016] id: CT #2 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 19/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [20:00:00 19/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 19/01/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 19/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 19/01/2016] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 19/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 19/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 19/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 19/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Other Remarks st: NotStopd t0: [20:00:00 19/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 19/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 19/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [20:00:00 19/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [20:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 19/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 19/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 19/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [20:00:00 19/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 19/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 19/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 19/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [20:00:00 19/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 19/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [20:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 19/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 19/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 19/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 19/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 19/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 19/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 19/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [20:00:00 19/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 19/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 19/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 19/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [20:00:00 19/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 19/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 19/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 19/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [20:00:00 19/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 19/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 19/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 19/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 19/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 19/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 19/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 19/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 19/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 19/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 19/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [20:00:00 19/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 19/01/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [20:00:00 19/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [20:00:00 19/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 19/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [20:00:00 19/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 19/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 6 mm v2: 6 mm st: NotStopd t0: [20:00:00 19/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 19/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 19/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 19/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [20:00:00 19/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 19/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 19/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 19/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 19/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 19/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [20:00:00 19/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [20:00:00 19/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [20:00:00 19/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 19/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 19/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 19/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 19/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 19/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 129 rs: Manual st: NotStopd t0: [20:00:00 19/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 19/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 19/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [20:00:00 19/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 19/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [20:00:00 19/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 19/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [20:00:00 19/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 19/01/2016] id: CT #1 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [20:00:00 19/01/2016] id: CT #1 Drainage el: 0 cu: MICU cg: RN v1: Serosanguinous st: NotStopd t0: [20:00:00 19/01/2016] id: CT #1 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [20:00:00 19/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 19/01/2016] id: CT #1 Suction Amount el: 0 cu: MICU cg: RN v1: 20 cm st: NotStopd t0: [20:00:00 19/01/2016] id: CT #2 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [20:00:00 19/01/2016] id: CT #2 Drainage el: 0 cu: MICU cg: RN v1: Serosanguinous st: NotStopd
t0: [20:00:00 19/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml t0: [20:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 3 vu: ml t0: [20:00:00 19/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml t0: [20:00:00 19/01/2016] tf: [08:00:00 03/02/2016] dt: 20880 id: Gastric Nasogastric el: 1 cu: MICU cg: RN vo: 120 vu: ml t0: [20:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [20:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [20:00:00 19/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 19/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 19/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 19/01/2016] dt: 24 id: Gastric Out Total el: 2 cu: MICU cg: RN cv: 120 ap: none
t0: [20:50:00 19/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [20:50:00 19/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:50:00 19/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [20:50:00 19/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [20:50:00 19/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [20:50:00 19/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [20:50:00 19/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:50:00 19/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:50:00 19/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [20:50:00 19/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:50:00 19/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:50:00 19/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.2 u1: L/min st: NotStopd t0: [20:50:00 19/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:50:00 19/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:50:00 19/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [20:50:00 19/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [20:50:00 19/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [20:50:00 19/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [20:50:00 19/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:50:00 19/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:50:00 19/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [20:50:00 19/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [20:50:00 19/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 6 u1: sec st: NotStopd t0: [20:50:00 19/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [20:50:00 19/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:50:00 19/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:50:00 19/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [21:00:00 19/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 19/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 19/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 19/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 19/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 19/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [21:00:00 19/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [21:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 19/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 19/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [21:00:00 19/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 19/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 19/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [21:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [21:00:00 19/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 19/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 19/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 19/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [21:00:00 19/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [21:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [21:00:00 19/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 19/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 19/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 19/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 19/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 19/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: Done
t0: [21:00:00 19/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml t0: [21:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 3 vu: ml t0: [21:00:00 19/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml t0: [21:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [21:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [21:00:00 19/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 19/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 19/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 19/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 240 ap: none
t0: [22:00:00 19/01/2016] id: CT #1 Crepitus el: 0 cu: MICU cg: -1 st: D/C'd t0: [22:00:00 19/01/2016] id: CT #1 Drainage el: 0 cu: MICU cg: -1 st: D/C'd t0: [22:00:00 19/01/2016] id: CT #1 Dressing el: 0 cu: MICU cg: -1 st: D/C'd t0: [22:00:00 19/01/2016] id: CT #1 Fluctuate/Leak el: 0 cu: MICU cg: -1 st: D/C'd t0: [22:00:00 19/01/2016] id: CT #1 Suction Amount el: 0 cu: MICU cg: -1 st: D/C'd
t0: [22:00:00 19/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 19/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 19/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 19/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 19/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [22:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 19/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [22:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [22:00:00 19/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 19/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [22:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [22:00:00 19/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 19/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 19/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 124 rs: Manual st: NotStopd
t0: [22:00:00 19/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml t0: [22:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 3 vu: ml t0: [22:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [22:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [22:00:00 19/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 19/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 19/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [22:31:00 19/01/2016] id: Chest Tube Site #1 el: 0 cu: MICU cg: -1 st: D/C'd
t0: [22:30:00 19/01/2016] id: CT #2 Dressing el: 0 cu: MICU cg: RN v1: Changed st: NotStopd t0: [22:30:00 19/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [22:30:00 19/01/2016] id: CT #2 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [22:30:00 19/01/2016] id: Chest Tube Site #1 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [22:30:00 19/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd
t0: [23:00:00 19/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 19/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 19/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 19/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 19/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 19/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [23:00:00 19/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 19/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [23:00:00 19/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [23:00:00 19/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 19/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [23:00:00 19/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [23:00:00 19/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 19/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 19/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml t0: [23:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 3 vu: ml t0: [23:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [23:00:00 19/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [23:00:00 19/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 19/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 19/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 19/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 230 cv: 230 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 29 cv: 2501.08 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: IV Nutrition Total el: 2 cu: MICU cg: RN pv: 58.3 cv: 1399.2 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 230 cv: 3530 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 230 cv: 3675 ap: carryForward
t0: [00:00:00 20/01/2016] id: CT #2 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [00:00:00 20/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [00:00:00 20/01/2016] id: CT #2 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [00:00:00 20/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 20/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 20/01/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 20/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 20/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 20/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Other Remarks st: NotStopd t0: [00:00:00 20/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 20/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [00:00:00 20/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [00:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 20/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 20/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [00:00:00 20/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 20/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 20/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 20/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Undigested Food st: NotStopd t0: [00:00:00 20/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [00:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [00:00:00 20/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 20/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 20/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 20/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 20/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 20/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 20/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [00:00:00 20/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 20/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 20/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 20/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [00:00:00 20/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 20/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 20/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 20/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [00:00:00 20/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 20/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 20/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 20/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 20/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 20/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 20/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 20/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 20/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 20/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [00:00:00 20/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 20/01/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [00:00:00 20/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [00:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [00:00:00 20/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 20/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 6 mm v2: 6 mm st: NotStopd t0: [00:00:00 20/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 20/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 20/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 20/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [00:00:00 20/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 20/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 20/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 20/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 20/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [00:00:00 20/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [00:00:00 20/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 20/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 20/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 20/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.9444 u1: Deg. C st: NotStopd t0: [00:00:00 20/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 96.7 u1: Deg. F st: NotStopd t0: [00:00:00 20/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 20/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 20/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 20/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 20/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 108 rs: Manual st: NotStopd t0: [00:00:00 20/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 20/01/2016] id: CT #2 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [00:00:00 20/01/2016] id: CT #2 Drainage el: 0 cu: MICU cg: RN v1: Serosanguinous st: NotStopd t0: [00:30:00 20/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [00:30:00 20/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:30:00 20/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:30:00 20/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:30:00 20/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:30:00 20/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:30:00 20/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [00:30:00 20/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [00:30:00 20/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd
t0: [00:00:00 20/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml t0: [00:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 3 vu: ml t0: [00:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [00:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [00:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 20/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 19/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -142.7 cv: -142.7 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 87.3 cv: 4720.28 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 580 ap: none t0: [23:00:00 19/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -142.7 cv: 1045.28 ap: carryForward t0: [23:00:00 19/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -142.7 cv: 15173.5 ap: carryForward t0: [23:00:00 20/01/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 1010 ap: none
t0: [01:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [01:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [01:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [01:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [01:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [01:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 20/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml t0: [01:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 3 vu: ml t0: [01:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [01:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [01:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 20/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [01:00:00 20/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [01:00:00 20/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [01:00:00 20/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [01:00:00 20/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [01:00:00 20/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [01:00:00 20/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [01:00:00 20/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:00:00 20/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 20/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [01:00:00 20/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [01:00:00 20/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [01:00:00 20/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.7 u1: L/min st: NotStopd t0: [01:00:00 20/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 20/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 20/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [01:00:00 20/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 4 u1: BPM st: NotStopd t0: [01:00:00 20/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [01:00:00 20/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [01:00:00 20/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [01:00:00 20/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [01:00:00 20/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [01:00:00 20/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 6 u1: sec st: NotStopd t0: [01:00:00 20/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [01:00:00 20/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [01:00:00 20/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [01:00:00 20/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [01:00:00 20/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: None st: NotStopd
t0: [02:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [02:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [02:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [02:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [02:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [02:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 20/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 103 rs: Manual st: NotStopd
t0: [02:00:00 20/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml t0: [02:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 3 vu: ml t0: [02:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [02:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [02:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 20/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [03:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [03:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [03:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [03:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [03:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [03:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 20/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml t0: [03:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 3 vu: ml t0: [03:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [03:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [03:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 20/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [23:00:00 20/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 310 cv: 310 ap: none t0: [23:00:00 20/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -226.7 cv: -226.7 ap: none t0: [23:00:00 20/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 15 cv: 1215 ap: none t0: [23:00:00 20/01/2016] dt: 24 id: IV Nutrition Total el: 2 cu: MICU cg: RN pv: 58.3 cv: 1399.2 ap: none t0: [23:00:00 20/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 83.3 cv: 3744.2 ap: none t0: [23:00:00 20/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 310 cv: 3545 ap: none t0: [23:00:00 20/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -226.7 cv: -10.8001 ap: none t0: [23:00:00 20/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 310 cv: 3755 ap: none t0: [23:00:00 20/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -226.7 cv: 15162.7 ap: carryForward
t0: [04:00:00 20/01/2016] id: CT #2 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [04:00:00 20/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [04:00:00 20/01/2016] id: CT #2 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [04:00:00 20/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 20/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 20/01/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 20/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 20/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 20/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Other Remarks st: NotStopd t0: [04:00:00 20/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 20/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [04:00:00 20/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [04:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 20/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 20/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [04:00:00 20/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 20/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 20/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 20/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [04:00:00 20/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [04:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 20/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 20/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 20/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 20/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 20/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 20/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 20/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [04:00:00 20/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 20/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [04:00:00 20/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 20/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [04:00:00 20/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 20/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 20/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 20/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 20/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 20/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 20/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 20/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 20/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 20/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 20/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 20/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 20/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 20/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [04:00:00 20/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 20/01/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [04:00:00 20/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Doppler v2: Doppler st: NotStopd t0: [04:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [04:00:00 20/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 20/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [04:00:00 20/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 20/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 20/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 20/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [04:00:00 20/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 20/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 20/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 20/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 20/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [04:00:00 20/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [04:00:00 20/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [04:00:00 20/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 20/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 20/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.1667 u1: Deg. C st: NotStopd t0: [04:00:00 20/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.1 u1: Deg. F st: NotStopd t0: [04:00:00 20/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 20/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 20/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 20/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 20/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 94 rs: Manual st: NotStopd t0: [04:00:00 20/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 20/01/2016] id: CT #2 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [04:00:00 20/01/2016] id: CT #2 Drainage el: 0 cu: MICU cg: RN v1: Serosanguinous st: NotStopd
t0: [04:00:00 20/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml t0: [04:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 3 vu: ml t0: [04:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [04:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [04:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 20/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [04:29:00 20/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.34 rs: Final st: NotStopd t0: [04:29:00 20/01/2016] id: CaO2 el: 0 cu: MICU cg: 1663 v1: 13.9216 u1: ml/dl st: NotStopd t0: [04:29:00 20/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 81 rs: Final st: NotStopd t0: [04:29:00 20/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 3 rs: Final st: NotStopd t0: [04:29:00 20/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [04:29:00 20/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 57 u1: mmHg rs: Final st: NotStopd t0: [04:29:00 20/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 170 u1: mmHg rs: Final st: NotStopd t0: [04:29:00 20/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.34 rs: Final st: NotStopd t0: [04:29:00 20/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 81 rs: Final st: NotStopd t0: [04:29:00 20/01/2016] id: SaO2 ABG's el: 0 cu: MICU cg: 1663 v1: 98 u1: % rs: Final st: NotStopd
t0: [05:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 20/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [05:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [05:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 20/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 20/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [05:00:00 20/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 20/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [05:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [05:00:00 20/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [05:00:00 20/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 20/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [05:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [05:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [05:00:00 20/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 20/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 20/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [05:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [05:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [05:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 20/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
t0: [05:00:00 20/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: RN ai: 168 vo: 10 vu: ml st: Stopped
t0: [04:55:00 20/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 29.8 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 29.8 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 31.7 u1: % rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10 u1: gm/dl rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 618 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.32 u1: /mic l rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 29.8 rs: Final st: NotStopd
t0: [04:55:00 20/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 13.2 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 28.9 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 13.2 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 28.9 rs: Final st: NotStopd
t0: [20:50:00 19/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [01:00:00 20/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [05:30:00 20/01/2016] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [05:30:00 20/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [05:30:00 20/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [05:30:00 20/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [05:30:00 20/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [05:30:00 20/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:30:00 20/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [05:30:00 20/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:30:00 20/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:30:00 20/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [05:30:00 20/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:30:00 20/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:30:00 20/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [05:30:00 20/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:30:00 20/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:30:00 20/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [05:30:00 20/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [05:30:00 20/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [05:30:00 20/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [05:30:00 20/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [05:30:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [05:30:00 20/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [05:30:00 20/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [05:30:00 20/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 6 u1: sec st: NotStopd t0: [05:30:00 20/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [05:30:00 20/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 354 u1: ml/B st: NotStopd t0: [05:30:00 20/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [05:30:00 20/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [05:30:00 20/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:55:00 20/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 62 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 76 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 u1: mEq/L rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 144 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 62 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 76 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 u1: mEq/L rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 144 rs: Final st: NotStopd
t0: [06:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [06:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [06:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [06:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.2 u1: kg st: NotStopd t0: [06:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [06:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 20/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 94 rs: Manual st: NotStopd
t0: [06:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [06:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [06:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml
t0: [06:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 20/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip
io: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ra: 10 ru: ml/hr
t0: [07:00:00 20/01/2016] id: D5W IV Infusions el: 1 cu: MICU cg: -1 ai: 168 vo: 0 st: D/C'd
id: .9% Normal Saline el: 1 cu: MICU cg: RN io: .9% Normal Saline 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push
t0: [08:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 20/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 20/01/2016] id: Readmit <48 hrs el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 20/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 20/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [08:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [08:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [08:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [08:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd
t0: [08:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 20/01/2016] id: CT #2 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [08:00:00 20/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [08:00:00 20/01/2016] id: CT #2 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [08:00:00 20/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 20/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 20/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [08:00:00 20/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 20/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 20/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [08:00:00 20/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 20/01/2016] id: GI Guaiac/ph el: 0 cu: MICU cg: RN v1: Negative v2: 6 st: NotStopd t0: [08:00:00 20/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 20/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 20/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [08:00:00 20/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 20/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [08:00:00 20/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 20/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 20/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 20/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 20/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 20/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 20/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 20/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 20/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [08:00:00 20/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 20/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 20/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 20/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 20/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [08:00:00 20/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [08:00:00 20/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [08:00:00 20/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 20/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.6111 u1: Deg. C st: NotStopd t0: [08:00:00 20/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 96.1 u1: Deg. F st: NotStopd t0: [08:00:00 20/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 20/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 20/01/2016] id: BSA - English el: 0 cu: MICU cg: RN v1: 1.14795 u1: m2 st: NotStopd t0: [08:00:00 20/01/2016] id: BSA - Metric el: 0 cu: MICU cg: RN v1: 1.34186 u1: m2 st: NotStopd t0: [08:00:00 20/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 20/01/2016] id: Daily Weight el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [08:00:00 20/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 20/01/2016] id: CT #2 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [08:00:00 20/01/2016] id: CT #2 Drainage el: 0 cu: MICU cg: RN v1: Sanguinous st: NotStopd
t0: [08:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 4 vu: ml t0: [08:00:00 20/01/2016] id: Gastric Nasogastric el: 1 cu: MICU cg: RN vo: 60 vu: ml t0: [08:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 6 vu: ml t0: [08:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 6 vu: ml
t0: [23:00:00 20/01/2016] dt: 24 id: Gastric Out Total el: 2 cu: MICU cg: RN cv: 60 ap: none
t0: [08:00:00 20/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 20/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [08:00:00 20/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 20/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 20/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 20/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 20/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 20/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [08:00:00 20/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 20/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 20/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 20/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [08:00:00 20/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 20/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 20/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 20/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 20/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 20/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 20/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 20/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 20/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 20/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 20/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 20/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 20/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 20/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 20/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 20/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 20/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 20/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 20/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 20/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 20/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 20/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 20/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 20/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [08:00:00 20/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [08:00:00 20/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 78 rs: Manual st: NotStopd
t0: [08:00:00 20/01/2016] id: Insulin el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: Uhr sv: 100 su: ml rt: IV Drip st: Stopped
t0: [09:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [09:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [09:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [09:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [09:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [09:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [09:00:00 20/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [09:00:00 20/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [09:00:00 20/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [09:00:00 20/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [09:00:00 20/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [09:00:00 20/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [09:00:00 20/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [09:00:00 20/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [09:00:00 20/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [09:00:00 20/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [09:00:00 20/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [09:00:00 20/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [09:00:00 20/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [09:00:00 20/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [09:00:00 20/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [09:00:00 20/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [09:00:00 20/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [09:00:00 20/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [09:00:00 20/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [09:00:00 20/01/2016] id: TCPCV Fixed I Time el: 0 cu: MICU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [09:00:00 20/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [09:00:00 20/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [09:00:00 20/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [09:00:00 20/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [09:00:00 20/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 290 u1: ml/B st: NotStopd t0: [09:00:00 20/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [09:00:00 20/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [09:15:00 20/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd
t0: [09:00:00 20/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 67 rs: Manual st: NotStopd t0: [10:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [10:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [10:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [10:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [10:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [10:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 3 vu: ml st: Stopped t0: [10:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 4 vu: ml t0: [10:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 6 vu: ml
t0: [10:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:30:00 20/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd
t0: [11:30:00 20/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [11:30:00 20/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [11:30:00 20/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [11:30:00 20/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [11:30:00 20/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [11:30:00 20/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [11:30:00 20/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:30:00 20/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:30:00 20/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [11:30:00 20/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.96 u1: L/min st: NotStopd t0: [11:30:00 20/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:30:00 20/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:30:00 20/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [11:30:00 20/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [11:30:00 20/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [11:30:00 20/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [11:30:00 20/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [11:30:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [11:30:00 20/01/2016] id: TCPCV Fixed I Time el: 0 cu: MICU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [11:30:00 20/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [11:30:00 20/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [11:30:00 20/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [11:30:00 20/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [11:30:00 20/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 270 u1: ml/B st: NotStopd t0: [11:30:00 20/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [11:30:00 20/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [11:30:00 20/01/2016] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd t0: [11:30:00 20/01/2016] id: ETT Position Change el: 0 cu: MICU cg: RRT v1: Done st: NotStopd
t0: [12:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 20/01/2016] id: Readmit <48 hrs el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 20/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [12:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [12:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [12:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [12:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [12:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [12:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:30:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 3 vu: ml t0: [11:30:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 4.5 vu: ml
t0: [12:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 20/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 20/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.1111 u1: Deg. C st: NotStopd t0: [12:00:00 20/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 95.2 u1: Deg. F st: NotStopd
t0: [08:00:00 20/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Sluggish st: NotStopd t0: [10:00:00 20/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [10:00:00 20/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 20/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [10:00:00 20/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 20/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 20/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [10:00:00 20/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 20/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 20/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [10:00:00 20/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 20/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: done t0: [11:00:00 20/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 85 rs: Manual st: NotStopd t0: [12:00:00 20/01/2016] id: CT #2 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [12:00:00 20/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [12:00:00 20/01/2016] id: CT #2 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [12:00:00 20/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [12:00:00 20/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 20/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 20/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [12:00:00 20/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 20/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 20/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 20/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [12:00:00 20/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [12:00:00 20/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 20/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [12:00:00 20/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 20/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 20/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [12:00:00 20/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 20/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 20/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 20/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 20/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [12:00:00 20/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [12:00:00 20/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 20/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [12:00:00 20/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 20/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [12:00:00 20/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [12:00:00 20/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [12:00:00 20/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serous v2: Moderate st: NotStopd t0: [12:00:00 20/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 20/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [12:00:00 20/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [12:00:00 20/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [12:00:00 20/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [12:00:00 20/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 20/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 20/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 20/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 20/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [12:00:00 20/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [12:00:00 20/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 20/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 20/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 20/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 20/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 20/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 20/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 20/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 20/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 20/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 20/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 20/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 20/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [12:00:00 20/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: None st: NotStopd t0: [12:00:00 20/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [12:00:00 20/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [12:00:00 20/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 20/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 20/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 20/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 20/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 20/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 20/01/2016] id: CT #2 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [12:00:00 20/01/2016] id: CT #2 Drainage el: 0 cu: MICU cg: RN v1: Sanguinous st: NotStopd
t0: [12:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 1 vu: ml t0: [12:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.5 vu: ml
t0: [11:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 55 u1: BPM st: NotStopd t0: [11:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [11:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [11:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [11:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [11:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [11:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
pt: TPN tf: [11:00:00 21/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 12 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml
t0: [12:00:00 20/01/2016] tf: [07:00:00 21/01/2016] dt: 1140 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml nb: 1
t0: [12:00:00 20/01/2016] id: Procedures el: 0 cu: MICU cg: RN v1: Paracentesis st: NotStopd t0: [13:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 54 u1: BPM st: NotStopd t0: [13:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [13:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [13:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [13:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [13:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [13:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 20/01/2016] tf: [08:00:00 03/02/2016] dt: 19920 id: paracentesis el: 1 cu: MICU cg: RN vo: 150 vu: ml t0: [13:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [13:00:00 20/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [13:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [13:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [13:00:00 20/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 92 rs: Manual st: NotStopd t0: [14:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 20/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [14:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [14:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 20/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 20/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [14:00:00 20/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 89 u2: mmHg st: NotStopd t0: [14:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [14:00:00 20/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 20/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 20/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [14:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [14:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [14:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 20/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 20/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml st: Stopped t0: [10:00:00 20/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vu: ml t0: [11:30:00 20/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vu: ml t0: [12:00:00 20/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vu: ml t0: [13:00:00 20/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vu: ml t0: [14:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [14:00:00 20/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [14:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [14:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 20/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Sluggish st: NotStopd t0: [12:00:00 20/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 5 mm v2: 5 mm st: NotStopd
t0: [13:45:00 20/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [13:45:00 20/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [13:45:00 20/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [13:45:00 20/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [13:45:00 20/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [13:45:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [13:45:00 20/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [13:45:00 20/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [13:45:00 20/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [13:45:00 20/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [13:45:00 20/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [13:45:00 20/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [13:45:00 20/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [13:45:00 20/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [13:45:00 20/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [13:45:00 20/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [13:45:00 20/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [13:45:00 20/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [13:45:00 20/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [13:45:00 20/01/2016] id: TCPCV Fixed I Time el: 0 cu: MICU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [13:45:00 20/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [13:45:00 20/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [13:45:00 20/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [13:45:00 20/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [13:45:00 20/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 305 u1: ml/B st: NotStopd t0: [13:45:00 20/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [13:45:00 20/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [16:00:00 20/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 102 rs: Manual st: NotStopd
t0: [15:42:00 20/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [15:42:00 20/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [15:42:00 20/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [15:42:00 20/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 55 u1: mmHg rs: Final st: NotStopd t0: [15:42:00 20/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 149 u1: mmHg rs: Final st: NotStopd t0: [15:42:00 20/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd
tf: [14:00:00 26/01/2016] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metronidazole v1: 500 u1: mg
t0: [04:55:00 20/01/2016] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: <4 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 11 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 87 rs: Final st: NotStopd t0: [04:55:00 20/01/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd
t0: [17:00:00 20/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [17:00:00 20/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [17:00:00 20/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [17:00:00 20/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [17:00:00 20/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 20/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 20/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 20/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 20/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [17:00:00 20/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 20/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:00:00 20/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.88 u1: L/min st: NotStopd t0: [17:00:00 20/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 20/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 20/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [17:00:00 20/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [17:00:00 20/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [17:00:00 20/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [17:00:00 20/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [17:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [17:00:00 20/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [17:00:00 20/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [17:00:00 20/01/2016] id: TCPCV Fixed I Time el: 0 cu: MICU cg: RRT v1: Insp. Time Fixed st: NotStopd t0: [17:00:00 20/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [17:00:00 20/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [17:00:00 20/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [17:00:00 20/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [17:00:00 20/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 305 u1: ml/B st: NotStopd t0: [17:00:00 20/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [17:00:00 20/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 20/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [15:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [15:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [15:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [15:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [15:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [15:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [15:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [16:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [16:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [16:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [16:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [16:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 20/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [17:00:00 20/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [17:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [17:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [17:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [17:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [17:00:00 20/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [17:00:00 20/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.6667 u1: Deg. C st: NotStopd t0: [17:00:00 20/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 96.2 u1: Deg. F st: NotStopd t0: [17:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 6 vu: ml t0: [17:00:00 20/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml t0: [17:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 9 vu: ml t0: [17:30:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 1 vu: ml t0: [17:30:00 20/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 5 vu: ml t0: [17:30:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.5 vu: ml
t0: [15:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 20/01/2016] id: CT #2 Dressing el: 0 cu: MICU cg: RN v1: Dry and Intact st: NotStopd t0: [16:00:00 20/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [16:00:00 20/01/2016] id: CT #2 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [16:00:00 20/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [16:00:00 20/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 20/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [16:00:00 20/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 20/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 20/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [16:00:00 20/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 20/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 20/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 20/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 20/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 20/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [16:00:00 20/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [16:00:00 20/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [16:00:00 20/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [16:00:00 20/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 20/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 20/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 20/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 20/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 20/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [16:00:00 20/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 20/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Pleural Friction st: NotStopd t0: [16:00:00 20/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 20/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 20/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [16:00:00 20/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [16:00:00 20/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [16:00:00 20/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 20/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 20/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 20/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 20/01/2016] id: CT #2 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [16:00:00 20/01/2016] id: CT #2 Drainage el: 0 cu: MICU cg: RN v1: Sanguinous st: NotStopd
t0: [16:00:00 20/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 20/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Fam Talked to MD st: NotStopd t0: [16:00:00 20/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 20/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [16:00:00 20/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 20/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [16:00:00 20/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [16:00:00 20/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [16:00:00 20/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 20/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 20/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 20/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 20/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 20/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 20/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [16:00:00 20/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 20/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd
t0: [17:00:00 20/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [17:00:00 20/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [17:00:00 20/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [17:00:00 20/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [17:00:00 20/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [17:00:00 20/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [17:00:00 20/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [17:00:00 20/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [17:00:00 20/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [17:00:00 20/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 20/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [17:00:00 20/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 20/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [17:00:00 20/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 20/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [17:00:00 20/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd
t0: [18:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [18:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [18:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [18:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [18:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:00:00 20/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd
t0: [18:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 1 vu: ml t0: [18:00:00 20/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 5 vu: ml t0: [18:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.5 vu: ml
t0: [19:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [19:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [19:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [19:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [19:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [19:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [19:00:00 20/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [19:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [19:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 20/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [20:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [20:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [20:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [20:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [20:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [20:00:00 20/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [20:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [20:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 20/01/2016] id: CT #2 Dressing el: 0 cu: MICU cg: RN v1: Changed st: NotStopd t0: [20:00:00 20/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: MICU cg: RN v1: Positive v2: Negative st: NotStopd t0: [20:00:00 20/01/2016] id: CT #2 Suction Amount el: 0 cu: MICU cg: RN v1: H2O Seal st: NotStopd t0: [20:00:00 20/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [20:00:00 20/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 20/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [20:00:00 20/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 20/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 20/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [20:00:00 20/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 20/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 20/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 20/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [20:00:00 20/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 20/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [20:00:00 20/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [20:00:00 20/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 20/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 20/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 20/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 20/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [20:00:00 20/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 20/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 20/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 20/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 20/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [20:00:00 20/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 20/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 20/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [20:00:00 20/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [20:00:00 20/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 20/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 20/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 20/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 20/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 20/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 20/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 20/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 20/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 20/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [20:00:00 20/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 20/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 20/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 20/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 20/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [20:00:00 20/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [20:00:00 20/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [20:00:00 20/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [20:00:00 20/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 20/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 20/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 20/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 20/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 20/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 20/01/2016] id: CT #2 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [20:00:00 20/01/2016] id: CT #2 Drainage el: 0 cu: MICU cg: RN v1: Sanguinous st: NotStopd
t0: [20:00:00 20/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 20/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [20:00:00 20/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd
t0: [21:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [21:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [21:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [21:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [21:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [21:00:00 20/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [21:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [21:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [21:05:00 20/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [21:05:00 20/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [21:05:00 20/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [21:05:00 20/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [21:05:00 20/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [21:05:00 20/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [21:05:00 20/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [21:05:00 20/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [21:05:00 20/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [21:05:00 20/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [21:05:00 20/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [21:05:00 20/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [21:05:00 20/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [21:05:00 20/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [21:05:00 20/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [21:05:00 20/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [21:05:00 20/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [21:05:00 20/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [21:05:00 20/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [21:05:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [21:05:00 20/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [21:05:00 20/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [21:05:00 20/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [21:05:00 20/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [21:05:00 20/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 302 u1: ml/B st: NotStopd t0: [21:05:00 20/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [21:05:00 20/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [21:05:00 20/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [22:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [22:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [22:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [22:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [22:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [22:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [22:00:00 20/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [22:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [22:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 20/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [23:00:00 20/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 20/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 20/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 20/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 20/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 20/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [23:00:00 20/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 20/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [23:00:00 20/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [23:00:00 20/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [23:00:00 20/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [23:00:00 20/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [23:00:00 20/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [23:00:00 20/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [23:00:00 20/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 20/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 20/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 10 cv: 120 ap: none
t0: [00:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [00:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [00:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [00:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [00:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [00:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 21/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 82 rs: Manual st: NotStopd
t0: [00:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [00:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [00:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [00:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [01:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [01:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [01:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [01:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [01:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [01:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [01:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [01:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [01:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 21/01/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 500 ap: none
t0: [00:00:00 21/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 21/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [00:00:00 21/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd
t0: [00:00:00 21/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [00:00:00 21/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 21/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 21/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [00:00:00 21/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 21/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 21/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [00:00:00 21/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 21/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 21/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 21/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [00:00:00 21/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 21/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 21/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 21/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 21/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 21/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 21/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 21/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [00:00:00 21/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 21/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 21/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 21/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [00:00:00 21/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [00:00:00 21/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 21/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 21/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 21/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 21/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 21/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 21/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 21/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [00:00:00 21/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 21/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 21/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 21/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [00:00:00 21/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [00:00:00 21/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 21/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 21/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 21/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 21/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 21/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 21/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 21/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 21/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 21/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [00:00:00 21/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [00:00:00 21/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 11 u1: number st: NotStopd t0: [00:00:00 21/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 21/01/2016] id: CT #2 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [02:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 21/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [02:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [02:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [02:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [02:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [02:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 21/01/2016] id: TCPCV Fixed I Time el: 0 cu: MICU cg: -1 st: D/C'd t0: [02:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [02:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [02:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [02:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 21/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: 1663 pv: 190 cv: 190 ap: none t0: [23:00:00 21/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -116.7 cv: -116.7 ap: none t0: [23:00:00 21/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 15 cv: 746 ap: none t0: [23:00:00 21/01/2016] dt: 24 id: IV Nutrition Total el: 2 cu: MICU cg: 1663 pv: 58.3 cv: 1399.2 ap: none t0: [23:00:00 21/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 73.3 cv: 2805.2 ap: none t0: [23:00:00 21/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: 1663 cv: 160 ap: none t0: [23:00:00 21/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: 1663 pv: 190 cv: 3380 ap: none t0: [23:00:00 21/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -116.7 cv: -574.8 ap: none t0: [23:00:00 21/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: 1663 pv: 190 cv: 3380 ap: none t0: [23:00:00 21/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -116.7 cv: 14587.9 ap: carryForward
t0: [02:05:00 21/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [02:05:00 21/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [02:05:00 21/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [02:05:00 21/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [02:05:00 21/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [02:05:00 21/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [02:05:00 21/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [02:05:00 21/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [02:05:00 21/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [02:05:00 21/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [02:05:00 21/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [02:05:00 21/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [02:05:00 21/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [02:05:00 21/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [02:05:00 21/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [02:05:00 21/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [02:05:00 21/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [02:05:00 21/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [02:05:00 21/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [02:05:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [02:05:00 21/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [02:05:00 21/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [02:05:00 21/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [02:05:00 21/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [02:05:00 21/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [02:05:00 21/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 12 st: NotStopd t0: [02:05:00 21/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 337 u1: ml/B st: NotStopd t0: [02:05:00 21/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [02:05:00 21/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [02:05:00 21/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [03:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [03:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [03:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [03:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [03:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [03:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 21/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [04:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [04:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 284 u1: mmHg st: NotStopd t0: [04:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [04:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [04:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 21/01/2016] tf: [02:00:00 22/01/2016] dt: 1380 id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [03:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [03:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [03:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [04:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [04:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [04:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [03:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:00:00 21/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 18.8 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 18.8 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 31.9 u1: % rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.8 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 632 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.36 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 18.8 rs: Final st: NotStopd
t0: [05:10:00 21/01/2016] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [05:10:00 21/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [05:10:00 21/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [05:10:00 21/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [05:10:00 21/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [05:10:00 21/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [05:10:00 21/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [05:10:00 21/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:10:00 21/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:10:00 21/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [05:10:00 21/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:10:00 21/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:10:00 21/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [05:10:00 21/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:10:00 21/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:10:00 21/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [05:10:00 21/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [05:10:00 21/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [05:10:00 21/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [05:10:00 21/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [05:10:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [05:10:00 21/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [05:10:00 21/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [05:10:00 21/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [05:10:00 21/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [05:10:00 21/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 323 u1: ml/B st: NotStopd t0: [05:10:00 21/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [05:10:00 21/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [05:10:00 21/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 21/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 13.7 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 31.8 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 13.7 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 31.8 rs: Final st: NotStopd
t0: [20:00:00 20/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 20/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 20/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 20/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [20:00:00 20/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [20:00:00 20/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 20/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 20/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 20/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 20/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 20/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 20/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 20/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 20/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 20/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 21/01/2016] id: CT #2 Suction Amount el: 0 cu: MICU cg: RN st: NotStopd t0: [00:00:00 21/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 21/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 21/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [00:00:00 21/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [00:00:00 21/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 21/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [00:00:00 21/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 21/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [00:00:00 21/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [00:00:00 21/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [00:00:00 21/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 21/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 21/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 21/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [00:00:00 21/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 21/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 21/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 21/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [00:00:00 21/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 21/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [04:00:00 21/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 21/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [04:00:00 21/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 21/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [04:00:00 21/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 21/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 21/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [04:00:00 21/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 21/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 21/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 21/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 21/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 21/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 21/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 21/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [04:00:00 21/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 21/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [04:00:00 21/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 21/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 21/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 21/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 21/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 21/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 21/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 21/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 21/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 21/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 21/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 21/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 21/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 21/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 21/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [04:00:00 21/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 21/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 21/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 21/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 21/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [04:00:00 21/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [04:00:00 21/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [04:00:00 21/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 21/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [04:00:00 21/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [04:00:00 21/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 21/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 21/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 21/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 21/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 21/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: DONE t0: [04:00:00 21/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 21/01/2016] id: CT #2 Crepitus el: 0 cu: MICU cg: RN v1: Positive st: NotStopd t0: [05:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [05:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [05:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [05:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [05:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [05:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [05:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 4 vu: ml t0: [05:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [05:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [05:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 21/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 21/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 21/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [04:00:00 21/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [04:00:00 21/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 21/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 21/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [04:00:00 21/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 21/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 21/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 21/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 21/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 21/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 21/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [04:00:00 21/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [04:00:00 21/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 21/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd
t0: [04:00:00 21/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 63 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 105 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 75 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 5.2 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 143 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 63 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 105 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 75 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 5.2 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [04:00:00 21/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 143 rs: Final st: NotStopd
t0: [06:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [06:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [06:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [06:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [06:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [06:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [06:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [06:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [06:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [06:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 21/01/2016] id: CT #2 Dressing el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 21/01/2016] id: CT #2 Fluctuate/Leak el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 21/01/2016] id: CT #2 Suction Amount el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 21/01/2016] id: CT #2 Crepitus el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 21/01/2016] id: CT #2 Drainage el: 0 cu: MICU cg: -1 st: D/C'd
t0: [08:00:00 21/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [08:00:00 21/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 21/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:00:00 21/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [08:00:00 21/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [08:00:00 21/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [08:00:00 21/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [08:00:00 21/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 21/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [08:00:00 21/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [08:00:00 21/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 21/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 21/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [08:00:00 21/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [08:00:00 21/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [08:00:00 21/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [08:00:00 21/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 21/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [08:00:00 21/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [08:00:00 21/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [08:00:00 21/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 12 st: NotStopd t0: [08:00:00 21/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 325 u1: ml/B st: NotStopd t0: [08:00:00 21/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [08:00:00 21/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 21/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [07:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [07:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [07:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [07:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [07:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [07:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 21/01/2016] id: Chest Tube Site #2 el: 0 cu: MICU cg: RN v1: Left Anterior st: NotStopd t0: [08:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 21/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 21/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [08:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 21/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 21/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [08:00:00 21/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 21/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 21/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 21/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 21/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 21/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 21/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [08:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [08:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 21/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [08:00:00 21/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 21/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 21/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 21/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 21/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 21/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [08:00:00 21/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 21/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 21/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 21/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 21/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 21/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 21/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [08:00:00 21/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 21/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [08:00:00 21/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [08:00:00 21/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 21/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 21/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 21/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 21/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 21/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 21/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 21/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 21/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 21/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 21/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 21/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [08:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [08:00:00 21/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 21/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [08:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 21/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [08:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [08:00:00 21/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 21/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [08:00:00 21/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 21/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 21/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [08:00:00 21/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 21/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 21/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 21/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [08:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 21/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [08:00:00 21/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [08:00:00 21/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [08:00:00 21/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 21/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 21/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3889 u1: Deg. C st: NotStopd t0: [08:00:00 21/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.5 u1: Deg. F st: NotStopd t0: [08:00:00 21/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 21/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 21/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 21/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 21/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 21/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [07:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 2 vu: ml t0: [08:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 116.6 vu: ml t0: [08:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 6 vu: ml
t0: [07:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [07:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vu: ml st: Stopped t0: [08:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vu: ml
t0: [08:00:00 21/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 69 rs: Manual st: NotStopd
t0: [09:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [09:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [09:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [09:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [09:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [09:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [10:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [10:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [10:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [10:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [10:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 116.6 vu: ml t0: [10:00:00 21/01/2016] tf: [06:00:00 22/01/2016] dt: 1200 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml st: Restart t0: [10:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 6 vu: ml
t0: [09:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 21/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 21/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 21/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 21/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 21/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 21/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 21/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 21/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 21/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [11:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 21/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [11:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [11:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 21/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 21/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 21/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [11:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [11:00:00 21/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [11:00:00 21/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 21/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [11:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [11:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [11:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 21/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [11:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 21/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 21/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [12:00:00 21/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 21/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 21/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 21/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [12:00:00 21/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 21/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 21/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 21/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [12:00:00 21/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 21/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [12:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 21/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [12:00:00 21/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 21/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 21/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 21/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 21/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [12:00:00 21/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [12:00:00 21/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 21/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [12:00:00 21/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 21/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [12:00:00 21/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [12:00:00 21/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 21/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [12:00:00 21/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [12:00:00 21/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 21/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 21/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 21/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 21/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 21/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 21/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 21/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 21/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 21/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 21/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 21/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [12:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [12:00:00 21/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [12:00:00 21/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [12:00:00 21/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [12:00:00 21/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 21/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 21/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [12:00:00 21/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 21/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 21/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 21/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 21/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [12:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 21/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [12:00:00 21/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [12:00:00 21/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [12:00:00 21/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 21/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 21/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [12:00:00 21/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [12:00:00 21/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 21/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 21/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 21/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 21/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [11:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [11:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vo: 8 vu: ml t0: [11:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [11:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [11:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
tf: [14:00:00 21/01/2016] pt: TPN tf: [11:00:00 24/01/2016] pt: IV Piggyback rt: IV fr: Q12H fs: 12, 0 dn: 2 m1: Cefepime v1: 2 u1: gm m2: D5W v2: 100 u2: ml
t0: [10:00:00 21/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 61 rs: Manual st: NotStopd t0: [12:00:00 21/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 64 rs: Manual st: NotStopd
t0: [12:00:00 21/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [12:00:00 21/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 21/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [12:00:00 21/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [12:00:00 21/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:00:00 21/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:00:00 21/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [12:00:00 21/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 21/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [12:00:00 21/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 21/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 21/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.2 u1: L/min st: NotStopd t0: [12:00:00 21/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 21/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 21/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [12:00:00 21/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 4 u1: BPM st: NotStopd t0: [12:00:00 21/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [12:00:00 21/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [12:00:00 21/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:00:00 21/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [12:00:00 21/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [12:00:00 21/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [12:00:00 21/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [12:00:00 21/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [12:00:00 21/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 12 st: NotStopd t0: [12:00:00 21/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 322 u1: ml/B st: NotStopd t0: [12:00:00 21/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [12:00:00 21/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 21/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
tf: [12:00:00 22/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 13 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [12:00:00 22/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 13 dn: 1 m1: Dextrose 50% v1: 25 u1: gm
tf: [15:00:00 03/02/2016] pt: Unit Dose rt: IV fr: QID fs: 10, 14, 18, 22 dn: 4 m1: Metoclopramide v1: 10 u1: mg tf: [15:00:00 03/02/2016] pt: Unit Dose rt: PO fr: QID fs: 10, 14, 18, 22 dn: 4 m1: Metoclopramide v1: 10 u1: mg
t0: [14:00:00 21/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 78 rs: Manual st: NotStopd
t0: [13:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [13:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [13:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [13:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [13:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [13:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [14:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [14:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [14:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [14:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [14:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [14:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 20/01/2016] id: Previous Weight el: 0 cu: MICU cg: RRT v1: 70.2 u1: kg st: NotStopd t0: [08:00:00 20/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RRT u1: kg st: NotStopd t0: [08:00:00 20/01/2016] id: Weight Change el: 0 cu: MICU cg: RRT v1: 0.4 u1: kg st: NotStopd t0: [08:00:00 20/01/2016] id: calprevflg el: 0 cu: MICU cg: RRT u1: kg st: NotStopd t0: [14:00:00 21/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd
t0: [14:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 174.9 vu: ml t0: [14:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml t0: [14:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 9 vu: ml
pt: TPN
t0: [14:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [15:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [15:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [15:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [15:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [15:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:29:00 21/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [15:29:00 21/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 3 rs: Final st: NotStopd t0: [15:29:00 21/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 31 rs: Final st: NotStopd t0: [15:29:00 21/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 53 u1: mmHg rs: Final st: NotStopd t0: [15:29:00 21/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 116 u1: mmHg rs: Final st: NotStopd t0: [15:29:00 21/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [16:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [16:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [16:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [16:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [16:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [16:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [14:00:00 21/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [14:00:00 21/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 21/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 21/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 21/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [14:00:00 21/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 21/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [14:00:00 21/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 21/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 21/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [16:00:00 21/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 21/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 21/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 21/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [16:00:00 21/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 21/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 21/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 21/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 21/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 21/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 21/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 21/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 21/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 21/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [16:00:00 21/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 21/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [16:00:00 21/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [16:00:00 21/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 21/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [16:00:00 21/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 21/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 21/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [16:00:00 21/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 21/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [16:00:00 21/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [16:00:00 21/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 21/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 21/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 21/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 21/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [16:00:00 21/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [16:00:00 21/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 21/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 21/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 21/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 21/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 21/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [16:00:00 21/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [16:00:00 21/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [16:00:00 21/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 21/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 21/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 21/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 21/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 21/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [16:00:00 21/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [16:00:00 21/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [16:00:00 21/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [16:00:00 21/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 21/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 21/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 21/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 21/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [17:00:00 21/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 21/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [17:00:00 21/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 21/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [17:00:00 21/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 21/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 21/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [17:00:00 21/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 21/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [17:00:00 21/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 21/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [17:00:00 21/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [16:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 116.6 vu: ml t0: [16:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 20 vu: ml t0: [16:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 6 vu: ml
t0: [17:00:00 21/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [17:00:00 21/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [17:00:00 21/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [17:00:00 21/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [17:00:00 21/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [17:00:00 21/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [17:00:00 21/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 21/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 21/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [17:00:00 21/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 21/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:00:00 21/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [17:00:00 21/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 21/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 21/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [17:00:00 21/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [17:00:00 21/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [17:00:00 21/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [17:00:00 21/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [17:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 95 u1: % st: NotStopd t0: [17:00:00 21/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [17:00:00 21/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [17:00:00 21/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [17:00:00 21/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 12 st: NotStopd t0: [17:00:00 21/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 345 u1: ml/B st: NotStopd t0: [17:00:00 21/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [17:00:00 21/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 21/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [17:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [17:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [17:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [17:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [17:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [17:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [18:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 113 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [18:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [18:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [18:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 116.6 vu: ml t0: [18:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 20 vu: ml t0: [18:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 6 vu: ml
t0: [17:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [19:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [19:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml
t0: [19:00:00 21/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 52 rs: Manual st: NotStopd
t0: [19:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [19:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [19:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [19:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [19:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [19:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [19:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 21/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 21/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 21/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [20:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 21/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 21/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 21/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 21/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [20:00:00 21/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 21/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 21/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 21/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 21/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 21/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [20:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 21/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 21/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 21/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 21/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 21/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 21/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [20:00:00 21/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 21/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 21/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 21/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 21/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 21/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [20:00:00 21/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [20:00:00 21/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 21/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 21/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 21/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 21/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 21/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 21/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [20:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [20:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 21/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [20:00:00 21/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 21/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [20:00:00 21/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [20:00:00 21/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 21/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 21/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 21/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [20:00:00 21/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [20:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [20:00:00 21/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [20:00:00 21/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [20:00:00 21/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [20:00:00 21/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 21/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 21/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 21/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 21/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 21/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 21/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [14:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vu: ml t0: [16:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vu: ml t0: [19:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: RN ai: 209 vu: ml t0: [19:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vu: ml t0: [19:00:00 21/01/2016] tf: [21:00:00 23/01/2016] dt: 3000 id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml t0: [20:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [20:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [20:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [19:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 21/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: 2827 v1: 25cm v2: Lip st: NotStopd t0: [20:00:00 21/01/2016] id: FiO2 Set el: 0 cu: MICU cg: 2827 v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 21/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 35 u1: cmH2O st: NotStopd t0: [20:00:00 21/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: 2827 v1: 10 u1: BPM st: NotStopd t0: [20:00:00 21/01/2016] id: Airway Size el: 0 cu: MICU cg: 2827 v1: 7.5 mm st: NotStopd t0: [20:00:00 21/01/2016] id: Airway Type el: 0 cu: MICU cg: 2827 v1: Endotracheal st: NotStopd t0: [20:00:00 21/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: 2827 v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 21/01/2016] id: Intubation Date el: 0 cu: MICU cg: 2827 v1: 12 v2: 23 st: NotStopd t0: [20:00:00 21/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: 2827 v1: 9 st: NotStopd t0: [20:00:00 21/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: 2827 v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 21/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: 2827 v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 21/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: 2827 v1: 10.8 u1: L/min st: NotStopd t0: [20:00:00 21/01/2016] id: PEEP Set el: 0 cu: MICU cg: 2827 v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 21/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: 2827 v1: 20 st: NotStopd t0: [20:00:00 21/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 27 u1: cmH2O st: NotStopd t0: [20:00:00 21/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: 2827 v1: 4 u1: BPM st: NotStopd t0: [20:00:00 21/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: 2827 v1: 36 u1: BPM st: NotStopd t0: [20:00:00 21/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: 2827 v1: 32 u1: BPM st: NotStopd t0: [20:00:00 21/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: 2827 v1: 10 u1: cmH2O st: NotStopd t0: [20:00:00 21/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: 2827 v1: 1:2.1 st: NotStopd t0: [20:00:00 21/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 19 u1: cmH2O st: NotStopd t0: [20:00:00 21/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: 2827 v1: 0.6 u1: sec st: NotStopd t0: [20:00:00 21/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: 2827 v1: 11 st: NotStopd t0: [20:00:00 21/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: 2827 v1: 360 u1: ml/B st: NotStopd t0: [20:00:00 21/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: 2827 v1: Pressure Control st: NotStopd t0: [20:00:00 21/01/2016] id: Ventilator Type el: 0 cu: MICU cg: 2827 v1: Drager st: NotStopd
t0: [20:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100Uhr Insulin IV Infusions el: 1 cu: MICU cg: -1 ai: 209 vo: 0 st: D/C'd
t0: [20:00:00 21/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 88 rs: Manual st: NotStopd
t0: [21:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [21:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [21:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [21:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [21:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [21:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [21:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [21:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [21:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [21:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 21/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 21/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [20:00:00 21/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd
t0: [22:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [22:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [22:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [22:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [22:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [22:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [22:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 21/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vu: ml t0: [22:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [22:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [22:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [22:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 21/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 21/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 21/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [23:00:00 21/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 21/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 21/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 21/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [23:00:00 21/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 21/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [23:00:00 21/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [23:00:00 21/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 21/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [23:00:00 21/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [23:00:00 21/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [23:00:00 21/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 21/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [23:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [23:00:00 21/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [23:00:00 21/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 21/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [01:00:00 21/01/2016] id: Previous Weight el: 0 cu: MICU cg: 1663 v1: 70.6 u1: kg st: NotStopd t0: [05:00:00 21/01/2016] id: Previous Weight el: 0 cu: MICU cg: 1663 v1: 70.6 u1: kg st: NotStopd t0: [21:00:00 21/01/2016] id: Previous Weight el: 0 cu: MICU cg: 1663 v1: 70.6 u1: kg st: NotStopd t0: [22:00:00 21/01/2016] id: Previous Weight el: 0 cu: MICU cg: 1663 v1: 70.6 u1: kg st: NotStopd t0: [23:00:00 21/01/2016] id: Previous Weight el: 0 cu: MICU cg: 1663 v1: 70.6 u1: kg st: NotStopd t0: [23:12:00 21/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [23:12:00 21/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 65 rs: Final st: NotStopd t0: [23:12:00 21/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [23:12:00 21/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [23:12:00 21/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 54 u1: mmHg rs: Final st: NotStopd t0: [23:12:00 21/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 107 u1: mmHg rs: Final st: NotStopd t0: [23:12:00 21/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [23:12:00 21/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 65 rs: Final st: NotStopd
io: D5W IV Infusions el: 2 cu: MICU cg: RN ra: 75 ru: ml/hr
id: D5W el: 2 cu: MICU cg: RN io: D5W IV Infusions du: ml rt: Intravenous Infusion
t0: [00:00:00 22/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [00:00:00 22/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 22/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [00:00:00 22/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 22/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [00:00:00 22/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [00:00:00 22/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 22/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 22/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 8 st: NotStopd t0: [00:00:00 22/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 22/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 22/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [00:00:00 22/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 22/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 22/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [00:00:00 22/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 4 u1: BPM st: NotStopd t0: [00:00:00 22/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [00:00:00 22/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [00:00:00 22/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:00:00 22/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [00:00:00 22/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [00:00:00 22/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [00:00:00 22/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [00:00:00 22/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [00:00:00 22/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [23:00:00 21/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 4 rs: Manual st: NotStopd t0: [00:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [00:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [00:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [00:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [00:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [00:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 22/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 73 rs: Manual st: NotStopd
t0: [00:00:00 22/01/2016] tf: [03:00:00 24/01/2016] dt: 3060 id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vu: ml nb: 1 t0: [00:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [00:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [00:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [00:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 22/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 22/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [00:00:00 22/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 22/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 22/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [00:00:00 22/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 22/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 22/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 22/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 22/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 22/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 22/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 22/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 22/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 22/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 22/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 22/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [00:00:00 22/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 22/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 22/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Dampened st: NotStopd t0: [00:00:00 22/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 22/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 22/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [00:00:00 22/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [00:00:00 22/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 22/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 22/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 22/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 22/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 22/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 22/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 22/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 22/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 22/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [00:00:00 22/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 22/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [00:00:00 22/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 22/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 22/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 22/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 22/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [00:00:00 22/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [00:00:00 22/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 22/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 22/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 22/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 22/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 22/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 22/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [01:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [01:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [01:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [01:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [01:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [01:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 22/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [01:00:00 22/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [01:00:00 22/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [01:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [01:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [01:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [01:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [02:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [02:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [02:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [02:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [02:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [02:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [02:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [02:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [03:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [03:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [03:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [03:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [03:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [03:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [03:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [03:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 22/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 200 cv: 200 ap: none t0: [23:00:00 22/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 200 cv: 2835 ap: none t0: [23:00:00 22/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 200 cv: 2835 ap: none
t0: [02:00:00 22/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 66 rs: Manual st: NotStopd
t0: [03:00:00 22/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [23:00:00 22/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -60.4 cv: -60.4 ap: none t0: [23:00:00 22/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 80 cv: 2467.6 ap: none t0: [23:00:00 22/01/2016] dt: 24 id: IV Nutrition Total el: 2 cu: MICU cg: RN pv: 59.6 cv: 820.1 ap: none t0: [23:00:00 22/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 139.6 cv: 3557.7 ap: none t0: [23:00:00 22/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 40 ap: none t0: [23:00:00 22/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -60.4 cv: 722.7 ap: none t0: [23:00:00 22/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -60.4 cv: 15310.6 ap: carryForward
tf: [10:00:00 13/02/2016] pt: Unit Dose rt: IV fr: PRN m1: Dextrose 50% v1: 12.5 u1: gm
t0: [02:00:00 22/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [04:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [04:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [04:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 70.6 u1: kg st: NotStopd t0: [04:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [04:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [04:00:00 22/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [04:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [04:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [04:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:00:00 22/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [04:00:00 22/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 22/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [04:00:00 22/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 22/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [04:00:00 22/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [04:00:00 22/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 22/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 22/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 8 st: NotStopd t0: [04:00:00 22/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 22/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 22/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.5 u1: L/min st: NotStopd t0: [04:00:00 22/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 22/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 22/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [04:00:00 22/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [04:00:00 22/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:00:00 22/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [04:00:00 22/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 22/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [04:00:00 22/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [04:00:00 22/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [04:00:00 22/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [04:00:00 22/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [04:00:00 22/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [04:00:00 22/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 21.3 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 21.3 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 28.8 u1: % rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.1 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 600 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.02 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 21.3 rs: Final st: NotStopd
t0: [04:00:00 22/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 67 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 73 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 5.6 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.7 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 67 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 73 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 5.6 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.7 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd
t0: [05:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 22/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [05:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [05:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [05:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 22/01/2016] id: Previous Weight el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [05:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [05:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [05:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 22/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [05:00:00 22/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.7778 u1: Deg. C st: NotStopd t0: [05:00:00 22/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100 u1: Deg. F st: NotStopd t0: [05:00:00 22/01/2016] id: BSA - English el: 0 cu: MICU cg: RN v1: 1.12873 u1: m2 st: NotStopd t0: [05:00:00 22/01/2016] id: BSA - Metric el: 0 cu: MICU cg: RN v1: 1.31989 u1: m2 st: NotStopd t0: [05:00:00 22/01/2016] id: Weight Change el: 0 cu: MICU cg: RN v1: 0 u1: kg st: NotStopd t0: [05:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 22/01/2016] id: Daily Weight el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd
t0: [05:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [05:00:00 22/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [05:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [05:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [05:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:00:00 22/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 15.5 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 39.6 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 15.5 rs: Final st: NotStopd t0: [04:00:00 22/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 39.6 rs: Final st: NotStopd
t0: [00:00:00 22/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 22/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 22/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 22/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 22/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 22/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [04:00:00 22/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 22/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 22/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 22/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [04:00:00 22/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 22/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 22/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [04:00:00 22/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 22/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 22/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 22/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 22/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 22/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 22/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 22/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 22/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [04:00:00 22/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 22/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [04:00:00 22/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Dampened st: NotStopd t0: [04:00:00 22/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 22/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 22/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [04:00:00 22/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 22/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 22/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 22/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 22/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 22/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 22/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 22/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 22/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 22/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 22/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 22/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [04:00:00 22/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 22/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 22/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 22/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [04:00:00 22/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 22/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 22/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 22/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 22/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 22/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 22/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 22/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [04:00:00 22/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 22/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 22/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 22/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 22/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 22/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 22/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: DONE t0: [04:00:00 22/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [06:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [06:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [06:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [06:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [06:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [06:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [06:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [06:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [06:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [07:00:00 22/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [07:00:00 22/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [07:00:00 22/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [07:00:00 22/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [07:00:00 22/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [07:00:00 22/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [07:00:00 22/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:00:00 22/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:00:00 22/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 8 st: NotStopd t0: [07:00:00 22/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:00:00 22/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:00:00 22/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.9 u1: L/min st: NotStopd t0: [07:00:00 22/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:00:00 22/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [07:00:00 22/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [07:00:00 22/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [07:00:00 22/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [07:00:00 22/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [07:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 93 u1: % st: NotStopd t0: [07:00:00 22/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [07:00:00 22/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [07:00:00 22/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [07:00:00 22/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 335 u1: ml/B st: NotStopd t0: [07:00:00 22/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [07:00:00 22/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [07:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [07:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [07:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [07:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [07:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [07:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/01/2016] id: Readmit <48 hrs el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 22/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [08:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [08:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [08:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [08:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [08:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:00:00 22/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 68 rs: Manual st: NotStopd t0: [08:00:00 22/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 22/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 87 rs: Manual st: NotStopd
t0: [07:00:00 22/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd
t0: [08:00:00 22/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 22/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [08:00:00 22/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 22/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 22/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 22/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [08:00:00 22/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [08:00:00 22/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 22/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 22/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 22/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 22/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 22/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 22/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 22/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 22/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 22/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 22/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [08:00:00 22/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 22/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 22/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 22/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 22/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [08:00:00 22/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 22/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 22/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 22/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 22/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 22/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 22/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 22/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 22/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [08:00:00 22/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 22/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 22/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 22/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 22/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 22/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 22/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [08:00:00 22/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 22/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [08:00:00 22/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 22/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 22/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 22/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 22/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 22/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 22/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 22/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 22/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 22/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 22/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 22/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 22/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 22/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 22/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 22/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 22/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [08:00:00 22/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 11 u1: number st: NotStopd t0: [08:00:00 22/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [02:00:00 22/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 174.9 vu: ml st: Stopped t0: [06:00:00 22/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml st: Stopped t0: [08:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 150 vu: ml t0: [08:00:00 22/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 0 vu: ml t0: [08:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 6 vu: ml t0: [08:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 4 vu: ml
t0: [08:00:00 22/01/2016] id: GI Guaiac/ph el: 0 cu: MICU cg: RN v1: Negative v2: 6 st: NotStopd t0: [08:00:00 22/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [08:00:00 22/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [08:00:00 22/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 22/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 22/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 22/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [08:00:00 22/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [08:00:00 22/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 22/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [08:00:00 22/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [09:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [09:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [09:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [09:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [09:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [09:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [09:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [09:00:00 22/01/2016] tf: [05:00:00 25/01/2016] dt: 4080 id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [09:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [09:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [09:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [10:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [10:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [10:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [10:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [10:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [10:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [10:00:00 22/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [10:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2.2 vu: ml t0: [10:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [10:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
tf: [10:00:00 23/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Phytonadione v1: 1 u1: mg
t0: [11:37:00 22/01/2016] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [11:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [11:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [11:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [11:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [11:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [11:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [11:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [12:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [12:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [12:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [12:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [12:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [12:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 150 vu: ml t0: [12:00:00 22/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 116.6 vu: ml t0: [12:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 4.4 vu: ml t0: [12:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 4 vu: ml
t0: [12:00:00 22/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 22/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [12:00:00 22/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 22/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 22/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 22/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [12:00:00 22/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [12:00:00 22/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [12:00:00 22/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 22/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [12:00:00 22/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 22/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 22/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 22/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 22/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 22/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 22/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 22/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 22/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 22/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [12:00:00 22/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [12:00:00 22/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 22/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [12:00:00 22/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 22/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 22/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [12:00:00 22/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [12:00:00 22/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 22/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [12:00:00 22/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [12:00:00 22/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples st: NotStopd t0: [12:00:00 22/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 22/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 22/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 22/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 22/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 22/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 22/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [12:00:00 22/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 22/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 22/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 22/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [12:00:00 22/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 22/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [12:00:00 22/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [12:00:00 22/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 22/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 22/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 22/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 22/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 22/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 22/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 22/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 22/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 22/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 22/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 22/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 22/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 22/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 98 rs: Manual st: NotStopd t0: [12:00:00 22/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
pt: TPN
t0: [12:07:00 22/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.38 rs: Final st: NotStopd t0: [12:07:00 22/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [12:07:00 22/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 29 rs: Final st: NotStopd t0: [12:07:00 22/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 47 u1: mmHg rs: Final st: NotStopd t0: [12:07:00 22/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 132 u1: mmHg rs: Final st: NotStopd t0: [12:07:00 22/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.38 rs: Final st: NotStopd
t0: [12:15:00 22/01/2016] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [12:00:00 22/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [12:00:00 22/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [12:00:00 22/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.4444 u1: Deg. C st: NotStopd t0: [12:00:00 22/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.6 u1: Deg. F st: NotStopd
t0: [12:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [12:35:00 22/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [12:35:00 22/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:35:00 22/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [12:35:00 22/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:35:00 22/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [12:35:00 22/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [12:35:00 22/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:35:00 22/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:35:00 22/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 8 st: NotStopd t0: [12:35:00 22/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 8 v2: Albuterol st: NotStopd t0: [12:35:00 22/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:35:00 22/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [12:35:00 22/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:35:00 22/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:35:00 22/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [12:35:00 22/01/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [12:35:00 22/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [12:35:00 22/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:35:00 22/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [12:35:00 22/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:35:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [12:35:00 22/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [12:35:00 22/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [12:35:00 22/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2 st: NotStopd t0: [12:35:00 22/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [12:35:00 22/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [12:35:00 22/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [12:35:00 22/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 330 u1: ml/B st: NotStopd t0: [12:35:00 22/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [12:35:00 22/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [13:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [13:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [13:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [13:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [13:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [13:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [13:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [14:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [14:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [14:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [14:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [14:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [14:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [15:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [15:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [15:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [15:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [15:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 225 vu: ml t0: [15:00:00 22/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 174.9 vu: ml t0: [15:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 9 vu: ml t0: [15:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 6 vu: ml
t0: [13:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [16:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [16:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [16:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [16:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [16:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 22/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 22/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.2222 u1: Deg. C st: NotStopd t0: [16:00:00 22/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.2 u1: Deg. F st: NotStopd t0: [16:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [16:00:00 22/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 58.3 vu: ml t0: [16:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [16:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [16:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:00:00 22/01/2016] id: ETT Position Change el: 0 cu: MICU cg: -1 st: D/C'd
t0: [18:00:00 22/01/2016] id: ETT Mark/Location el: 0 cu: MICU cg: RRT v1: 25cm v2: Lip st: NotStopd t0: [18:00:00 22/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [18:00:00 22/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [18:00:00 22/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [18:00:00 22/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 7.5 mm st: NotStopd t0: [18:00:00 22/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Endotracheal st: NotStopd t0: [18:00:00 22/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [18:00:00 22/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 8 st: NotStopd t0: [18:00:00 22/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [18:00:00 22/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [18:00:00 22/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [18:00:00 22/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [18:00:00 22/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [18:00:00 22/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [18:00:00 22/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [18:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [18:00:00 22/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2 st: NotStopd t0: [18:00:00 22/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [18:00:00 22/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [18:00:00 22/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 12 st: NotStopd t0: [18:00:00 22/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 245 u1: ml/B st: NotStopd t0: [18:00:00 22/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [18:00:00 22/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [18:00:00 22/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [18:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [18:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [18:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [18:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 41 u1: BPM st: NotStopd t0: [18:00:00 22/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [18:00:00 22/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.1667 u1: Deg. C st: NotStopd t0: [18:00:00 22/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.1 u1: Deg. F st: NotStopd t0: [18:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:05:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:05:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:05:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:05:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:05:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:05:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [18:05:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:05:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [18:05:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [18:05:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:05:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:05:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:05:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:05:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 150 vu: ml t0: [18:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 6 vu: ml t0: [18:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 4 vu: ml
t0: [18:05:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:05:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:10:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:10:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:10:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:10:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:10:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:10:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [18:10:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:10:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [18:10:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [18:10:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:10:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:10:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:10:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:10:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:10:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:10:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:14:00 22/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [18:14:00 22/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [18:14:00 22/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [18:14:00 22/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [18:14:00 22/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [18:14:00 22/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [18:14:00 22/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [18:14:00 22/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [18:14:00 22/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [18:14:00 22/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 8 st: NotStopd t0: [18:14:00 22/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 8 v2: Albuterol st: NotStopd t0: [18:14:00 22/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [18:14:00 22/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [18:14:00 22/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [18:14:00 22/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [18:14:00 22/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [18:14:00 22/01/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [18:14:00 22/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [18:14:00 22/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [18:14:00 22/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [18:14:00 22/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [18:14:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [18:14:00 22/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Tenacious st: NotStopd t0: [18:14:00 22/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [18:14:00 22/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2 st: NotStopd t0: [18:14:00 22/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [18:14:00 22/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [18:14:00 22/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [18:14:00 22/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 260 u1: ml/B st: NotStopd t0: [18:14:00 22/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [18:14:00 22/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [18:14:00 22/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [18:14:00 22/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [18:14:00 22/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [18:14:00 22/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [18:15:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:15:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:15:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:15:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:15:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:15:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [18:15:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:15:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [18:15:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [18:15:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:15:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:15:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [18:15:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:15:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:15:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:15:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:20:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:20:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:20:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:20:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:20:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:20:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [18:20:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:20:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [18:20:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [18:20:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:20:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:20:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:20:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:20:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:20:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:20:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:25:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:25:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:25:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:25:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:25:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:25:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [18:25:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:25:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [18:25:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [18:25:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:25:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:25:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [18:25:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:25:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:30:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:30:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [18:30:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:30:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [18:30:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [18:30:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:30:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:30:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:30:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:30:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:25:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:25:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:30:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:30:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:35:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:35:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:35:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:35:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:35:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:35:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [18:35:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:35:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [18:35:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [18:35:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:35:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:35:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:35:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:35:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:35:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:35:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:40:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:40:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:40:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:40:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:40:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:40:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [18:40:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:40:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [18:40:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [18:40:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:40:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:40:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:40:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:40:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:40:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:40:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:45:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:45:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:45:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:45:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:45:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:45:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [18:45:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:45:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [18:45:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [18:45:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:45:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:45:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:45:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:45:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:50:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:50:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:50:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:50:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:50:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:50:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:50:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:50:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [18:50:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [18:50:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:50:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:50:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [18:50:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:50:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:45:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:45:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:50:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:50:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [19:00:00 22/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: -1 st: D/C'd t0: [19:00:00 22/01/2016] id: Plateau Pressure el: 0 cu: MICU cg: -1 st: D/C'd
t0: [16:00:00 22/01/2016] id: Significant Events el: 0 cu: MICU cg: RN v1: OR Sent st: NotStopd t0: [18:00:00 22/01/2016] id: Significant Events el: 0 cu: MICU cg: RN v1: OR Received st: NotStopd
t0: [19:43:00 22/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [19:43:00 22/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [19:43:00 22/01/2016] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd t0: [19:43:00 22/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [19:43:00 22/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [19:43:00 22/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [19:43:00 22/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [19:43:00 22/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [19:43:00 22/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [19:43:00 22/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [19:43:00 22/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 8 st: NotStopd t0: [19:43:00 22/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.17 u1: L/min st: NotStopd t0: [19:43:00 22/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [19:43:00 22/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [19:43:00 22/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [19:43:00 22/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [19:43:00 22/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [19:43:00 22/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [19:43:00 22/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [19:43:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [19:43:00 22/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [19:43:00 22/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [19:43:00 22/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [19:43:00 22/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [19:43:00 22/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [19:43:00 22/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [19:43:00 22/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [19:43:00 22/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [19:43:00 22/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [19:43:00 22/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [19:43:00 22/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [19:43:00 22/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [19:43:00 22/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 22/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 22/01/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Change in Vitals st: NotStopd t0: [20:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 22/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 22/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [20:00:00 22/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 22/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 22/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 22/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 22/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 22/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 3 u1: points st: NotStopd t0: [20:00:00 22/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 22/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 22/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 22/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 22/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: Flat in Bed st: NotStopd t0: [20:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [20:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 22/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: Flat in Bed st: NotStopd t0: [20:00:00 22/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 22/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 22/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 22/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 22/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 22/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [20:00:00 22/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 22/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 22/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [20:00:00 22/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 22/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [20:00:00 22/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [20:00:00 22/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 22/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 22/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 22/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 22/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 22/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 22/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 22/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [20:00:00 22/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [20:00:00 22/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [20:00:00 22/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 22/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [20:00:00 22/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 22/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [20:00:00 22/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 22/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 22/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [20:00:00 22/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 22/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 22/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 22/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 22/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 22/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [20:00:00 22/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 22/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 22/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 22/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 22/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 22/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 22/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 22/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Walks Occasional st: NotStopd t0: [20:00:00 22/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [20:00:00 22/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 22/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 22/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 22/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [20:00:00 22/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [20:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 150 vu: ml t0: [20:00:00 22/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vu: ml nb: 1 t0: [20:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 6 vu: ml t0: [20:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 4 vu: ml
t0: [20:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 22/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 22/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 22/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [21:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [21:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [21:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [21:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [21:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [21:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [21:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [21:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [21:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [21:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [21:00:00 22/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 122 rs: Manual st: NotStopd
t0: [22:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 22/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [22:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [22:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [22:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [22:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [22:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [22:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [22:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [22:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [22:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 22/01/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 230 ap: none
t0: [21:00:00 22/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [22:00:00 22/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml
t0: [23:00:00 22/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 22/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 22/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [23:00:00 22/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 22/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 22/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 22/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [23:00:00 22/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [23:00:00 22/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [23:00:00 22/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [23:00:00 22/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 22/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [23:00:00 22/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [23:00:00 22/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 22/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 22/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [23:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [23:00:00 22/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [23:00:00 22/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 22/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 22/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [23:00:00 22/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [23:00:00 22/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [23:00:00 22/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [23:00:00 22/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [23:00:00 22/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [23:00:00 22/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [23:00:00 22/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [23:00:00 22/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [23:00:00 22/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [23:00:00 22/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 10 v2: Albuterol st: NotStopd t0: [23:00:00 22/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [23:00:00 22/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.3 u1: L/min st: NotStopd t0: [23:00:00 22/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [23:00:00 22/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [23:00:00 22/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [23:00:00 22/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [23:00:00 22/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [23:00:00 22/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [23:00:00 22/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [23:00:00 22/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [23:00:00 22/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [23:00:00 22/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [23:00:00 22/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [23:00:00 22/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 260 u1: ml/B st: NotStopd t0: [23:00:00 22/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [23:00:00 22/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [23:00:00 22/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [23:00:00 22/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [23:00:00 22/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [23:00:00 22/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [23:00:00 22/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 22/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip st: NotStopd t0: [00:00:00 23/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 23/01/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Change in Vitals st: NotStopd t0: [00:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 23/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 23/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 23/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [00:00:00 23/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 23/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 23/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 23/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 23/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [00:00:00 23/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 23/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 6 u1: points st: NotStopd t0: [00:00:00 23/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 23/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 23/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 23/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 23/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [00:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 23/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 23/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 23/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 23/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 23/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 23/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 23/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [00:00:00 23/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 23/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 23/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 23/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 23/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 23/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [00:00:00 23/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [00:00:00 23/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip st: NotStopd t0: [00:00:00 23/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 23/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 23/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 23/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 23/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 23/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [00:00:00 23/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 23/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 23/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [00:00:00 23/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [00:00:00 23/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 23/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 23/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [00:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [00:00:00 23/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 23/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [00:00:00 23/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 23/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 23/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [00:00:00 23/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Nail Bed v2: Withdraws st: NotStopd t0: [00:00:00 23/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 23/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 23/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [00:00:00 23/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 23/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Clear v2: Thin st: NotStopd t0: [00:00:00 23/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [00:00:00 23/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 23/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 23/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36 u1: Deg. C st: NotStopd t0: [00:00:00 23/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 96.8 u1: Deg. F st: NotStopd t0: [00:00:00 23/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 23/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 23/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 23/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 23/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [23:00:00 22/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [00:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [00:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [00:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [00:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 23/01/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 710 ap: none
t0: [01:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 23/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [01:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [01:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [01:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [01:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [01:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [01:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [01:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [01:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [01:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [01:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 23/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [02:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [02:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [02:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [02:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [02:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [02:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [02:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [02:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [02:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [02:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 23/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [03:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [03:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [03:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [03:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [03:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [03:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [03:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [03:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [03:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 23/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 100 cv: 100 ap: none t0: [23:00:00 23/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 39.1 cv: 39.1 ap: none t0: [23:00:00 23/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 79.5 cv: 2183.8 ap: none t0: [23:00:00 23/01/2016] dt: 24 id: IV Nutrition Total el: 2 cu: MICU cg: RN pv: 59.6 cv: 1430.4 ap: none t0: [23:00:00 23/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 139.1 cv: 4324.2 ap: none t0: [23:00:00 23/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 100 cv: 1860 ap: none t0: [23:00:00 23/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 39.1 cv: 2224.2 ap: none t0: [23:00:00 23/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 100 cv: 2100 ap: none t0: [23:00:00 23/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 39.1 cv: 17534.8 ap: carryForward
t0: [04:00:00 23/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 23/01/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Change in Vitals st: NotStopd t0: [04:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 23/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 23/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 23/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [04:00:00 23/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 23/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 23/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [04:00:00 23/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 23/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 6 u1: points st: NotStopd t0: [04:00:00 23/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 23/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 23/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 23/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 23/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [04:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 23/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 23/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 23/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 23/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 23/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 23/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [04:00:00 23/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 23/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 23/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 23/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 23/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 23/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 23/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Pink st: NotStopd t0: [04:00:00 23/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip st: NotStopd t0: [04:00:00 23/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 23/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 23/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 23/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 23/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 23/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [04:00:00 23/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 23/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 23/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 113 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [04:00:00 23/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [04:00:00 23/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 23/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 23/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [04:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 23/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [04:00:00 23/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [04:00:00 23/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [04:00:00 23/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 23/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 23/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [04:00:00 23/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Nail Bed v2: Withdraws st: NotStopd t0: [04:00:00 23/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 23/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 23/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 23/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 23/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [04:00:00 23/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [04:00:00 23/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 23/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 23/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [04:00:00 23/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [04:00:00 23/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 23/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 23/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 23/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 23/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [04:00:00 23/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 23/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [04:00:00 23/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 23/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [04:00:00 23/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [04:00:00 23/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 11 u1: number st: NotStopd t0: [04:00:00 23/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [04:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [04:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [04:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [04:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [04:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:49:00 23/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.29 rs: Final st: NotStopd t0: [04:49:00 23/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [04:49:00 23/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 29 rs: Final st: NotStopd t0: [04:49:00 23/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 58 u1: mmHg rs: Final st: NotStopd t0: [04:49:00 23/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 116 u1: mmHg rs: Final st: NotStopd t0: [04:49:00 23/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.29 rs: Final st: NotStopd
t0: [04:00:00 23/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 20.5 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 20.5 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 29.2 u1: % rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8.7 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 602 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.04 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 20.5 rs: Final st: NotStopd
t0: [04:00:00 23/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 16.6 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 41 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 16.6 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 41 rs: Final st: NotStopd
t0: [04:00:00 23/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 69 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 102 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 146 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 5.9 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.9 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 69 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 102 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 146 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 5.9 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.9 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd
t0: [06:00:00 23/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [06:00:00 23/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [06:00:00 23/01/2016] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: No Spon Resp st: NotStopd t0: [06:00:00 23/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [06:00:00 23/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [06:00:00 23/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [06:00:00 23/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [06:00:00 23/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [06:00:00 23/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [06:00:00 23/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [06:00:00 23/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [06:00:00 23/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [06:00:00 23/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [06:00:00 23/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.4 u1: L/min st: NotStopd t0: [06:00:00 23/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [06:00:00 23/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [06:00:00 23/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [06:00:00 23/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [06:00:00 23/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [06:00:00 23/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [06:00:00 23/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [06:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [06:00:00 23/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [06:00:00 23/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [06:00:00 23/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [06:00:00 23/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [06:00:00 23/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 262 u1: ml/B st: NotStopd t0: [06:00:00 23/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [06:00:00 23/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [06:00:00 23/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [06:00:00 23/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [06:00:00 23/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [06:00:00 23/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [06:00:00 23/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [05:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 23/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [05:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [05:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [05:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [05:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [05:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 23/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [06:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [06:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [06:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [06:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [06:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [05:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [05:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [05:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml t0: [06:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [06:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [06:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [06:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [05:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 175 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 23/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:00:00 23/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 23/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 23/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:00:00 23/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [08:00:00 23/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 23/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 23/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 23/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 23/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [08:00:00 23/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.65 u1: L/min st: NotStopd t0: [08:00:00 23/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 23/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 23/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [08:00:00 23/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 1 u1: BPM st: NotStopd t0: [08:00:00 23/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [08:00:00 23/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [08:00:00 23/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 23/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [08:00:00 23/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [08:00:00 23/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [08:00:00 23/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [08:00:00 23/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 23/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 23/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 23/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 23/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [08:00:00 23/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 23/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [08:00:00 23/01/2016] id: RSBI (<100) el: 0 cu: MICU cg: RRT u1: units st: NotStopd t0: [08:00:00 23/01/2016] id: RSBI (<200) el: 0 cu: MICU cg: RRT u1: units st: NotStopd t0: [08:00:00 23/01/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [08:00:00 23/01/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.06 u1: L st: NotStopd
t0: [08:00:00 23/01/2016] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd
t0: [08:00:00 23/01/2016] id: CVP el: 0 cu: MICU cg: -1 st: D/C'd
tf: [10:00:00 02/02/2016] pt: Unit Dose rt: PO fr: Q4H:PRN m1: Lactulose v1: 30 u1: ml
t0: [08:00:00 23/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 23/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 23/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 23/01/2016] id: Readmit <48 hrs el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 23/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [08:00:00 23/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 23/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 23/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 23/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [08:00:00 23/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 23/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 6 u1: points st: NotStopd t0: [08:00:00 23/01/2016] id: GI Guaiac/ph el: 0 cu: MICU cg: RN v1: Negative v2: 6 st: NotStopd t0: [08:00:00 23/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 23/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 23/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [08:00:00 23/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 23/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [08:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 23/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 23/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 23/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 23/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 23/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 23/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 23/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [08:00:00 23/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 23/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 23/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 23/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 23/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [08:00:00 23/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 23/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [08:00:00 23/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [08:00:00 23/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 23/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 23/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 23/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 23/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 23/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 23/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 23/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 23/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [08:00:00 23/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 23/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 23/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 23/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [08:00:00 23/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [08:00:00 23/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 23/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 23/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [08:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [08:00:00 23/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [08:00:00 23/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 23/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 23/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [08:00:00 23/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Nail Bed v2: Withdraws st: NotStopd t0: [08:00:00 23/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 23/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 23/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 23/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 23/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 23/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 23/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [08:00:00 23/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.4 u1: Deg. F st: NotStopd t0: [08:00:00 23/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 23/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 23/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 23/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 23/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 23/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: done t0: [08:00:00 23/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 23/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 23/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 23/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 23/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 23/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 23/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [08:00:00 23/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 10 u1: number st: NotStopd t0: [08:00:00 23/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Comp. Limited st: NotStopd
t0: [08:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 150 vu: ml t0: [08:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [08:00:00 23/01/2016] id: Gastric Nasogastric el: 1 cu: MICU cg: RN vo: 240 vu: ml t0: [08:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 7 vu: ml t0: [08:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 8 vu: ml
t0: [08:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 23/01/2016] dt: 24 id: Gastric Out Total el: 2 cu: MICU cg: RN cv: 240 ap: none
id: Lasix el: 100 cu: MICU cg: RN io: D5W 50.0ml + 100mghr Lasix IV Infusions am: 100 du: mghr rt: IV Drip
tf: [20:00:00 23/01/2016] pt: Unit Dose rt: PO fr: Q6H fs: 10, 16, 22, 4 dn: 4 m1: Diazepam v1: 5 u1: mg tf: [10:00:00 24/01/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Furosemide v1: 100 u1: mg m2: D5W v2: 50 u2: ml tf: [09:00:00 25/01/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Phytonadione v1: 5 u1: mg
id: D5W el: 1 cu: MICU cg: RN io: D5W 50.0ml + 100mghr Lasix IV Infusions vo: 50 du: ml rt: Intravenous Push
t0: [09:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [09:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [09:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [09:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [09:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [09:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [10:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [10:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [10:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [10:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [10:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 150 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 23/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 23/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 23/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [08:00:00 23/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd
t0: [09:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [09:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [09:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [09:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml t0: [10:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [10:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [10:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [10:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [04:00:00 23/01/2016] id: D-Dimer Coags el: 0 cu: MICU cg: 1663 v1: 3126 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: D-Dimer (0-500) Coags el: 0 cu: MICU cg: 1663 v1: 3126 rs: Final st: NotStopd
t0: [04:00:00 23/01/2016] id: Differential-Bands Hematology el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Differential-Basos Hematology el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Differential-Eos Hematology el: 0 cu: MICU cg: 1663 v1: 6 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Differential-Lymphs Hematology el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Differential-Monos Hematology el: 0 cu: MICU cg: 1663 v1: 6 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Differential-Polys Hematology el: 0 cu: MICU cg: 1663 v1: 84 rs: Final st: NotStopd
t0: [11:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [11:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [11:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [11:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [11:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [11:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [11:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [11:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [11:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 3 vu: ml t0: [11:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [11:00:00 23/01/2016] tf: [12:00:00 24/01/2016] dt: 1500 id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
pt: TPN
t0: [04:00:00 23/01/2016] id: Fibrinogen Coags el: 0 cu: MICU cg: 1663 v1: 468 rs: Final st: NotStopd t0: [04:00:00 23/01/2016] id: Fibrinogen (150-400) Coags el: 0 cu: MICU cg: 1663 v1: 468 rs: Final st: NotStopd
t0: [08:00:00 23/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [11:00:00 23/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:00:00 23/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [11:00:00 23/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:00:00 23/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 23/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:00:00 23/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:00:00 23/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:00:00 23/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.05 u1: L/min st: NotStopd t0: [11:00:00 23/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 23/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 23/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [11:00:00 23/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [11:00:00 23/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [11:00:00 23/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [11:00:00 23/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [11:00:00 23/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [11:00:00 23/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [11:00:00 23/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [11:00:00 23/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [11:00:00 23/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 260 u1: ml/B st: NotStopd t0: [11:00:00 23/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [11:00:00 23/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [11:00:00 23/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [12:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [12:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [12:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [12:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [12:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [12:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [12:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [12:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [12:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2.2 vu: ml t0: [12:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [11:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip
t0: [13:30:00 23/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [13:30:00 23/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [13:30:00 23/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [13:30:00 23/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [13:30:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [13:30:00 23/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 180 u1: ml/B st: NotStopd t0: [13:30:00 23/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [13:30:00 23/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [13:35:00 23/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd
t0: [13:30:00 23/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd
t0: [12:00:00 23/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 23/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.3333 u1: Deg. C st: NotStopd t0: [12:00:00 23/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 95.6 u1: Deg. F st: NotStopd t0: [13:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [13:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [13:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [13:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [13:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [13:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [13:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [14:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [14:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [14:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [14:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml
t0: [13:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [13:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 23/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 23/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [12:00:00 23/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 23/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 23/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [12:00:00 23/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 23/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 6 u1: points st: NotStopd t0: [12:00:00 23/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 23/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [12:00:00 23/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 23/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 23/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 23/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 23/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 23/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 23/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 23/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 23/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 23/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [12:00:00 23/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [12:00:00 23/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 23/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 23/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 23/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 23/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [12:00:00 23/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [12:00:00 23/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [12:00:00 23/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 23/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [12:00:00 23/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [12:00:00 23/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [12:00:00 23/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 23/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 23/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 23/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 23/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 23/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 23/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 23/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [12:00:00 23/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 23/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 23/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 23/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [12:00:00 23/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 23/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 23/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [12:00:00 23/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [12:00:00 23/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 23/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 23/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 23/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Nail Bed v2: Withdraws st: NotStopd t0: [12:00:00 23/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 23/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 23/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 23/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 23/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 23/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 23/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 23/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 23/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 23/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 153 rs: Manual st: NotStopd t0: [12:00:00 23/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [13:32:00 23/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 16.6 rs: Final st: NotStopd t0: [13:32:00 23/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [13:32:00 23/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 42.5 rs: Final st: NotStopd t0: [13:32:00 23/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [13:32:00 23/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 16.6 rs: Final st: NotStopd t0: [13:32:00 23/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 42.5 rs: Final st: NotStopd
t0: [14:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 150 vu: ml t0: [14:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [14:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 4.4 vu: ml t0: [14:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [14:00:00 23/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [14:00:00 23/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
tf: [14:00:00 24/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 15 dn: 1 m1: Furosemide v1: 40 u1: mg
t0: [15:42:00 23/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [15:42:00 23/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [15:42:00 23/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [15:42:00 23/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 51 u1: mmHg rs: Final st: NotStopd t0: [15:42:00 23/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 96 u1: mmHg rs: Final st: NotStopd t0: [15:42:00 23/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd
t0: [14:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [15:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [15:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [15:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [15:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [15:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [15:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [16:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [16:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd t0: [16:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [16:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [16:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [16:00:00 23/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [16:00:00 23/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.6667 u1: Deg. C st: NotStopd t0: [16:00:00 23/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 96.2 u1: Deg. F st: NotStopd t0: [16:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 150 vu: ml t0: [16:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [16:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 4.4 vu: ml t0: [16:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [15:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [16:00:00 23/01/2016] id: Midazolam el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 1 du: mghr sv: 50 su: ml rt: IV Drip st: Stopped
t0: [16:00:00 23/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 23/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [16:00:00 23/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 2 To pain st: NotStopd t0: [16:00:00 23/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 23/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [16:00:00 23/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 23/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [16:00:00 23/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 23/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 23/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 23/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 23/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 23/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [16:00:00 23/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [16:00:00 23/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [16:00:00 23/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 23/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 23/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Nail Bed v2: Withdraws st: NotStopd t0: [16:00:00 23/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 23/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 23/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 23/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd
t0: [11:00:00 23/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [11:00:00 23/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [11:00:00 23/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:00:00 23/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 23/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [16:00:00 23/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [16:00:00 23/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 23/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 23/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [16:00:00 23/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 23/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:00:00 23/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.5 u1: L/min st: NotStopd t0: [16:00:00 23/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 23/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 23/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [16:00:00 23/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [16:00:00 23/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [16:00:00 23/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [16:00:00 23/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:00:00 23/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [16:00:00 23/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [16:00:00 23/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [16:00:00 23/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [16:00:00 23/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 240 u1: ml/B st: NotStopd t0: [16:00:00 23/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [16:00:00 23/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 23/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [18:00:00 23/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [18:00:00 23/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [18:00:00 23/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [18:00:00 23/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd
t0: [17:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [17:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [17:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [17:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [17:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [17:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [17:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [18:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [18:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [18:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [18:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [18:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 150 vu: ml t0: [18:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [18:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 4.4 vu: ml t0: [18:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: RN ai: 431 vo: 2 vu: ml
t0: [17:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 23/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 23/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 23/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 23/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [16:00:00 23/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 23/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [16:00:00 23/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [16:00:00 23/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 23/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [16:00:00 23/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 23/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [16:00:00 23/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 23/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 23/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 23/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [16:00:00 23/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 23/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 23/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [18:00:00 23/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 138 rs: Manual st: NotStopd
t0: [20:00:00 23/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 23/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [20:00:00 23/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [20:00:00 23/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 23/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 23/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [20:00:00 23/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 23/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:00:00 23/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 23/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 23/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.25 u1: L/min st: NotStopd t0: [20:00:00 23/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 23/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 23/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [20:00:00 23/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [20:00:00 23/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [20:00:00 23/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [20:00:00 23/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 95 u1: % st: NotStopd t0: [20:00:00 23/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [20:00:00 23/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [20:00:00 23/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [20:00:00 23/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [20:00:00 23/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 233 u1: ml/B st: NotStopd t0: [20:00:00 23/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [20:00:00 23/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 23/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [19:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [19:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [19:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [19:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [19:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 11 u1: BPM st: NotStopd t0: [19:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [19:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 23/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Very Sedated st: NotStopd t0: [20:00:00 23/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [20:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 23/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 23/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 23/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 23/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 23/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 3 u1: points st: NotStopd t0: [20:00:00 23/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 23/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 23/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 23/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 23/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [20:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 23/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 23/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [20:00:00 23/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [20:00:00 23/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [20:00:00 23/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 23/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 23/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Ins/Exp Wheeze st: NotStopd t0: [20:00:00 23/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 23/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 23/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [20:00:00 23/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [20:00:00 23/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [20:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [20:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 23/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [20:00:00 23/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [20:00:00 23/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [20:00:00 23/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 23/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Pleural Friction st: NotStopd t0: [20:00:00 23/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [20:00:00 23/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Sternal Rub v2: Withdraws st: NotStopd t0: [20:00:00 23/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 23/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 23/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 23/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 23/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 23/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 23/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 23/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 23/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd
t0: [20:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [20:00:00 23/01/2016] tf: [20:00:00 24/01/2016] dt: 1440 id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [20:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 4.4 vu: ml
t0: [19:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 110 du: mcghr sv: 50 su: ml rt: IV Drip t0: [19:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 23/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [20:00:00 23/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
t0: [20:29:00 23/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.22 rs: Final st: NotStopd t0: [20:29:00 23/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [20:29:00 23/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [20:29:00 23/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 70 u1: mmHg rs: Final st: NotStopd t0: [20:29:00 23/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 92 u1: mmHg rs: Final st: NotStopd t0: [20:29:00 23/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.22 rs: Final st: NotStopd
t0: [21:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 100mghr Midazolam IV Infusions el: 1 cu: MICU cg: -1 ai: 431 vo: 0 st: D/C'd
tf: [20:00:00 24/01/2016] pt: Unit Dose rt: IV fr: ONCE MR1 fs: 21 dn: 1 m1: Bumetanide v1: 2 u1: mg tf: [18:00:00 25/01/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Fentanyl Citrate v1: 2500 u1: mcg m2: Soln. v2: 50 u2: ml
t0: [21:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [21:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [21:00:00 23/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [21:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2 vu: ml
t0: [20:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml
t0: [20:00:00 23/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 23/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 23/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 23/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [20:00:00 23/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [20:00:00 23/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 23/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd
t0: [21:27:00 23/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.34 rs: Final st: NotStopd t0: [21:27:00 23/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [21:27:00 23/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 31 rs: Final st: NotStopd t0: [21:27:00 23/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 55 u1: mmHg rs: Final st: NotStopd t0: [21:27:00 23/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 95 u1: mmHg rs: Final st: NotStopd t0: [21:27:00 23/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.34 rs: Final st: NotStopd
tf: [16:00:00 27/01/2016] pt: Unit Dose rt: PO fr: Q6H fs: 10, 16, 22, 4 dn: 4 m1: Diazepam v1: 2 u1: mg
t0: [20:00:00 23/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 23/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [20:00:00 23/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [21:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [21:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [21:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [21:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [21:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [21:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [21:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 23/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [22:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [22:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [22:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [22:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [22:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [22:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [22:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [22:00:00 23/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [22:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2 vu: ml
t0: [21:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 23/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [22:00:00 23/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [22:00:00 23/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 2 To pain st: NotStopd t0: [22:00:00 23/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [22:00:00 23/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 7 u1: points st: NotStopd t0: [22:00:00 23/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [22:00:00 23/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [22:00:00 23/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [22:00:00 23/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [22:00:00 23/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 23/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 23/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [22:00:00 23/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 23/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 23/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [22:00:00 23/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [22:00:00 23/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [22:00:00 23/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 23/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [22:00:00 23/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 23/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [22:00:00 23/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [22:00:00 23/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [22:00:00 23/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [22:00:00 23/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Nail Bed v2: Withdraws st: NotStopd t0: [22:00:00 23/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 23/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [22:00:00 23/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [22:00:00 23/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [22:00:00 23/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [22:00:00 23/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [23:00:00 23/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 23/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 23/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 23/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 23/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 23/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [23:00:00 23/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 23/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [23:00:00 23/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [23:00:00 23/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 23/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [23:00:00 23/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 11 u1: BPM st: NotStopd t0: [23:00:00 23/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [23:00:00 23/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 23/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [23:00:00 23/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [23:00:00 23/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [23:00:00 23/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2 vu: ml
t0: [23:00:00 23/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 23/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [00:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 24/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 24/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 24/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 24/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 24/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [00:00:00 24/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 24/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [00:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 75 u1: mmHg st: NotStopd t0: [00:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 24/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [00:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 9 u1: BPM st: NotStopd t0: [00:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 24/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [00:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [00:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [00:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2 vu: ml
t0: [00:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 24/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 24/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [00:00:00 24/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [00:00:00 24/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 24/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 24/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [00:00:00 24/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 24/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [00:00:00 24/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 24/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 24/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.69 u1: L/min st: NotStopd t0: [00:00:00 24/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 24/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 24/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [00:00:00 24/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [00:00:00 24/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [00:00:00 24/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [00:00:00 24/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 24/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [00:00:00 24/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 24/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [00:00:00 24/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [00:00:00 24/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [00:00:00 24/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [00:00:00 24/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 332 u1: ml/B st: NotStopd t0: [00:00:00 24/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [00:00:00 24/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 24/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [00:00:00 24/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 24/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [00:00:00 24/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd
t0: [00:00:00 24/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 142 rs: Manual st: NotStopd
t0: [01:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 24/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [01:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [01:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [01:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [01:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 24/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [01:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 9 u1: BPM st: NotStopd t0: [01:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 24/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [01:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [01:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [01:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2 vu: ml
t0: [01:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 24/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 24/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [00:00:00 24/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 24/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 24/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 24/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [00:00:00 24/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 24/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [00:00:00 24/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 24/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 24/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 24/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 24/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [00:00:00 24/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [00:00:00 24/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 24/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 24/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [00:00:00 24/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [00:00:00 24/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 24/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 24/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [00:00:00 24/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 24/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [00:00:00 24/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 24/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 24/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 24/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 24/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 24/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 24/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 24/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 24/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 24/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [02:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [02:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [02:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 70 u1: mmHg st: NotStopd t0: [02:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 24/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [02:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [02:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 24/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: RN ai: 112 vo: 75 vu: ml t0: [02:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [02:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [02:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2 vu: ml
t0: [02:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 24/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [02:00:00 24/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [02:00:00 24/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [02:00:00 24/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [02:00:00 24/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [02:00:00 24/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [02:00:00 24/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [02:00:00 24/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [02:00:00 24/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [02:00:00 24/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [02:00:00 24/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [02:00:00 24/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [02:00:00 24/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [02:00:00 24/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [02:00:00 24/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [02:00:00 24/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [02:00:00 24/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [02:00:00 24/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [02:00:00 24/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [02:00:00 24/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [02:00:00 24/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [02:00:00 24/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [02:00:00 24/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [02:00:00 24/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 24/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [02:00:00 24/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [02:00:00 24/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [02:00:00 24/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [02:00:00 24/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [03:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 24/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [03:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 24/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [03:00:00 24/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [03:00:00 24/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [03:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [03:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [03:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 71 u1: mmHg st: NotStopd t0: [03:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 24/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [03:00:00 24/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [03:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 13 u1: BPM st: NotStopd t0: [03:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [03:00:00 24/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [03:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [03:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [03:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2 vu: ml
t0: [03:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 24/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 24/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 111 cv: 111 ap: none t0: [23:00:00 24/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 1.4 cv: 754 ap: none t0: [23:00:00 24/01/2016] dt: 24 id: IV Nutrition Total el: 2 cu: MICU cg: RN pv: 59.6 cv: 1430.4 ap: none t0: [23:00:00 24/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 111 cv: 2284.4 ap: none t0: [23:00:00 24/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 2045 ap: none t0: [23:00:00 24/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 111 cv: -960.6 ap: none t0: [23:00:00 24/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 3245 ap: none t0: [23:00:00 24/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 111 cv: 16574.2 ap: carryForward
t0: [03:00:00 24/01/2016] id: D5W IV Infusions el: 2 cu: MICU cg: -1 ai: 112 vo: 0 st: D/C'd
t0: [04:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 24/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 24/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 24/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [04:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 24/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 24/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 24/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 24/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 6 u1: points st: NotStopd t0: [04:00:00 24/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 24/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [04:00:00 24/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 24/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 24/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [04:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 24/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 24/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 24/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 24/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 24/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [04:00:00 24/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 24/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [04:00:00 24/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 24/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [04:00:00 24/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [04:00:00 24/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 24/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 24/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 24/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 24/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 24/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 24/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [04:00:00 24/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [04:00:00 24/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 24/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [04:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [04:00:00 24/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 24/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 24/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 24/01/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 68.5 u1: kg st: NotStopd t0: [04:00:00 24/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [04:00:00 24/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 2 mm v2: 2 mm st: NotStopd t0: [04:00:00 24/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 24/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 24/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [04:00:00 24/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [04:00:00 24/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 24/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [04:00:00 24/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 24/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 24/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [04:00:00 24/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 24/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 24/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 24/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 24/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 24/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 24/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 24/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd
t0: [04:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [04:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [04:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2 vu: ml
t0: [04:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:34:00 24/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd t0: [04:34:00 24/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [04:34:00 24/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [04:34:00 24/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 51 u1: mmHg rs: Final st: NotStopd t0: [04:34:00 24/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 93 u1: mmHg rs: Final st: NotStopd t0: [04:34:00 24/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.36 rs: Final st: NotStopd
t0: [04:37:00 24/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:37:00 24/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:37:00 24/01/2016] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [04:37:00 24/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:37:00 24/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [04:37:00 24/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [04:37:00 24/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:37:00 24/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:37:00 24/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.5 u1: Deg. C st: NotStopd t0: [04:37:00 24/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:37:00 24/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [04:37:00 24/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:37:00 24/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:37:00 24/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.67 u1: L/min st: NotStopd t0: [04:37:00 24/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:37:00 24/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:37:00 24/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [04:37:00 24/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 3 u1: BPM st: NotStopd t0: [04:37:00 24/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:37:00 24/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [04:37:00 24/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [04:37:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [04:37:00 24/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [04:37:00 24/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [04:37:00 24/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [04:37:00 24/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [04:37:00 24/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [04:37:00 24/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [04:37:00 24/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 341 u1: ml/B st: NotStopd t0: [04:37:00 24/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:37:00 24/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:37:00 24/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:37:00 24/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:37:00 24/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [04:37:00 24/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:37:00 24/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [04:00:00 24/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 24/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [04:00:00 24/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd
t0: [04:20:00 24/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 24.7 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 24.7 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 29.9 u1: % rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.1 u1: gm/dl rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 548 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.05 u1: /mic l rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 24.7 rs: Final st: NotStopd
t0: [05:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [05:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [05:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [05:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [05:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [05:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [05:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [05:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2 vu: ml
t0: [05:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:20:00 24/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 70 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 104 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 122 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 5.1 u1: mEq/L rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 5.9 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 70 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 104 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 122 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 5.1 u1: mEq/L rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 5.9 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
t0: [06:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 24/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [06:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 24/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [06:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 24/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [06:00:00 24/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 24/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 6 u1: points st: NotStopd t0: [06:00:00 24/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [06:00:00 24/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [06:00:00 24/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [06:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [06:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 24/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [06:00:00 24/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [06:00:00 24/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 1 No Response st: NotStopd t0: [06:00:00 24/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [06:00:00 24/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [06:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [06:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [06:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 24/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [06:00:00 24/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [06:00:00 24/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [06:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [06:00:00 24/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [06:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [06:00:00 24/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 24/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [06:00:00 24/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [06:00:00 24/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [06:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 24/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd
t0: [06:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [06:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 2.5 vu: ml t0: [06:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2 vu: ml
t0: [06:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:20:00 24/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 15.6 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 44 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 15.6 rs: Final st: NotStopd t0: [04:20:00 24/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 44 rs: Final st: NotStopd
t0: [07:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [07:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [07:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [07:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [07:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [07:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 24/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 24/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/O2 Issues st: NotStopd t0: [08:00:00 24/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 24/01/2016] id: Readmit <48 hrs el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 24/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [08:00:00 24/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 24/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 24/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 24/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 24/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 24/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [08:00:00 24/01/2016] id: GI Guaiac/ph el: 0 cu: MICU cg: RN v1: Negative v2: 7 st: NotStopd t0: [08:00:00 24/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 24/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [08:00:00 24/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 24/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [08:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 24/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 24/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [08:00:00 24/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 24/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 24/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 24/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [08:00:00 24/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [08:00:00 24/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [08:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [08:00:00 24/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 24/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 24/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 24/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [08:00:00 24/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [08:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [08:00:00 24/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 24/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [08:00:00 24/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 24/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 24/01/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 24/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [08:00:00 24/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 24/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3889 u1: Deg. C st: NotStopd t0: [08:00:00 24/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.5 u1: Deg. F st: NotStopd t0: [08:00:00 24/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 24/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 24/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 24/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [08:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [08:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 6.25 vu: ml t0: [08:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 4 vu: ml
t0: [07:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 100 du: mcghr sv: 50 su: ml rt: IV Drip t0: [07:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 7.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [08:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 7.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 24/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 24/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 24/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 24/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 24/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 24/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 24/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [08:00:00 24/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [08:00:00 24/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 24/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 24/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 24/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [08:00:00 24/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [08:00:00 24/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 24/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 24/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 24/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 24/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 24/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [08:00:00 24/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 24/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [08:00:00 24/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 24/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 24/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 24/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 24/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 24/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 24/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 24/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: done t0: [08:00:00 24/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [08:00:00 24/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 24/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 24/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 24/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 24/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [08:00:00 24/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 10 u1: number st: NotStopd t0: [08:00:00 24/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Comp. Limited st: NotStopd
t0: [09:00:00 24/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [09:00:00 24/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [09:00:00 24/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [09:00:00 24/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [09:00:00 24/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [09:00:00 24/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.7 u1: Deg. C st: NotStopd t0: [09:00:00 24/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [09:00:00 24/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [09:00:00 24/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [09:00:00 24/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [09:00:00 24/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.9 u1: L/min st: NotStopd t0: [09:00:00 24/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [09:00:00 24/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [09:00:00 24/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [09:00:00 24/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [09:00:00 24/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [09:00:00 24/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [09:00:00 24/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [09:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [09:00:00 24/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [09:00:00 24/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [09:00:00 24/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [09:00:00 24/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [09:00:00 24/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [09:00:00 24/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [09:00:00 24/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [09:00:00 24/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [09:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [09:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [09:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [09:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [09:00:00 24/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [09:00:00 24/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [09:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [09:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 3.75 vu: ml t0: [09:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml
t0: [09:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [09:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 7.5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:00:00 24/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [10:00:00 24/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [10:00:00 24/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [10:00:00 24/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [10:00:00 24/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [10:00:00 24/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [10:00:00 24/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5.5 st: NotStopd t0: [10:00:00 24/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.6 u1: L/min st: NotStopd t0: [10:00:00 24/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [10:00:00 24/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [10:00:00 24/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [10:00:00 24/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [10:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [10:00:00 24/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 330 u1: ml/B st: NotStopd t0: [10:00:00 24/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [10:00:00 24/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [10:00:00 24/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [10:00:00 24/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [10:00:00 24/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 22 u1: . st: NotStopd
t0: [10:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [10:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [10:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [10:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [10:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [10:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 3.75 vu: ml t0: [10:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml
t0: [10:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [10:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 7.5 du: mghr sv: 50 su: ml rt: IV Drip
tf: [10:00:00 26/01/2016] pt: Unit Dose rt: IV fr: Q8H fs: 4, 12, 20 dn: 3 m1: Bumetanide v1: 2 u1: mg tf: [10:00:00 26/01/2016] pt: Unit Dose rt: PO fr: Q8H fs: 4, 12, 20 dn: 3 m1: Metolazone v1: 2.5 u1: mg
t0: [11:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [11:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [11:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [11:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [11:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 24/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [12:00:00 24/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 24/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 24/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [12:00:00 24/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 24/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 24/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 24/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [12:00:00 24/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 24/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [12:00:00 24/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 24/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 24/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [12:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 24/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 24/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [12:00:00 24/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [12:00:00 24/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [12:00:00 24/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 24/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [12:00:00 24/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [12:00:00 24/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [12:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [12:00:00 24/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 24/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 24/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 24/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [12:00:00 24/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [12:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 24/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 24/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [12:00:00 24/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [12:00:00 24/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 24/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [12:00:00 24/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 24/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.8889 u1: Deg. C st: NotStopd t0: [12:00:00 24/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 96.6 u1: Deg. F st: NotStopd t0: [12:00:00 24/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [12:00:00 24/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 24/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 24/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [12:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [12:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 7.5 vu: ml t0: [12:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2.8 vu: ml
t0: [11:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [11:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 7.5 du: mghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [12:00:00 24/01/2016] id: Lasix el: 1 cu: MICU cg: RN so: D5W vo: 0 v1: 7.5 du: mghr sv: 50 su: ml rt: IV Drip st: Stopped
t0: [12:00:00 24/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 24/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 24/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 24/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 24/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 24/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [12:00:00 24/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [12:00:00 24/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 24/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 24/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [12:00:00 24/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [12:00:00 24/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [12:00:00 24/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 24/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [12:00:00 24/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [12:00:00 24/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [12:00:00 24/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 24/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 24/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 24/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 24/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 24/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 24/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 24/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 24/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 24/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [12:00:00 24/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [12:00:00 24/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 24/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 24/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 24/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 24/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 24/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd
t0: [12:00:00 24/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 141 rs: Manual st: NotStopd
t0: [12:00:00 24/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:00:00 24/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 24/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 24/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [12:00:00 24/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [12:00:00 24/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 24/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 24/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 24/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 24/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5.5 st: NotStopd t0: [12:00:00 24/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [12:00:00 24/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.8 u1: L/min st: NotStopd t0: [12:00:00 24/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 24/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 24/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 22 u1: . st: NotStopd t0: [12:00:00 24/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [12:00:00 24/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [12:00:00 24/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [12:00:00 24/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:00:00 24/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [12:00:00 24/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 24/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:00:00 24/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:00:00 24/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:00:00 24/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:00:00 24/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 24/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [12:22:00 24/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd t0: [12:22:00 24/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [12:22:00 24/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [12:22:00 24/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 59 u1: mmHg rs: Final st: NotStopd t0: [12:22:00 24/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 97 u1: mmHg rs: Final st: NotStopd t0: [12:22:00 24/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.32 rs: Final st: NotStopd
t0: [13:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [13:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [13:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [13:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [13:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [13:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [13:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 3.75 vu: ml t0: [13:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml
t0: [13:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [14:00:00 24/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [14:00:00 24/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [14:00:00 24/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [14:00:00 24/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [14:00:00 24/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [14:00:00 24/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [14:00:00 24/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd
pt: TPN
t0: [14:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [14:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [14:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [14:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [14:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [14:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 24/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [15:00:00 24/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [15:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 24/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [15:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 24/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [15:00:00 24/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [15:00:00 24/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [15:00:00 24/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [15:00:00 24/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [15:00:00 24/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [15:00:00 24/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [15:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 24/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [15:00:00 24/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [15:00:00 24/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [15:00:00 24/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [15:00:00 24/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [15:00:00 24/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [15:00:00 24/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [15:00:00 24/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [15:00:00 24/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [15:00:00 24/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 24/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [15:00:00 24/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [15:00:00 24/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [15:00:00 24/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [15:00:00 24/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [15:00:00 24/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [15:00:00 24/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [15:00:00 24/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [15:00:00 24/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 24/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 24/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 24/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 24/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [15:00:00 24/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [15:00:00 24/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 24/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [15:00:00 24/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [15:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [15:00:00 24/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [15:00:00 24/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [15:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 24/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [15:00:00 24/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [15:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [15:00:00 24/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 24/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [15:00:00 24/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 24/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [15:00:00 24/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [15:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 24/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [15:00:00 24/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [15:00:00 24/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [15:00:00 24/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [15:00:00 24/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [15:00:00 24/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [15:00:00 24/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 24/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd
t0: [15:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [15:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 7.5 vu: ml t0: [15:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2.8 vu: ml
t0: [14:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [15:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 24/01/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 100 ap: none
t0: [15:00:00 24/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [15:00:00 24/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [15:00:00 24/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [15:00:00 24/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [15:00:00 24/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [15:00:00 24/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [15:00:00 24/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [15:00:00 24/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.8 u1: Deg. C st: NotStopd t0: [15:00:00 24/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [15:00:00 24/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5.5 st: NotStopd t0: [15:00:00 24/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [15:00:00 24/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.32 u1: L/min st: NotStopd t0: [15:00:00 24/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [15:00:00 24/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [15:00:00 24/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [15:00:00 24/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [15:00:00 24/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [15:00:00 24/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [15:00:00 24/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [15:00:00 24/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [15:00:00 24/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [15:00:00 24/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [15:00:00 24/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [15:00:00 24/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [15:00:00 24/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [15:00:00 24/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [15:00:00 24/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [15:00:00 24/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [15:00:00 24/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [15:00:00 24/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [15:00:00 24/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [15:00:00 24/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 2 To pain st: NotStopd t0: [15:00:00 24/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [15:00:00 24/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 7 u1: points st: NotStopd t0: [15:00:00 24/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 24/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 24/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 24/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [15:00:00 24/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [15:00:00 24/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [15:00:00 24/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [15:00:00 24/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [15:00:00 24/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [15:00:00 24/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [15:00:00 24/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 24/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [16:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [16:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [16:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [16:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [16:00:00 24/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [16:00:00 24/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.5 u1: Deg. C st: NotStopd t0: [16:00:00 24/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 95.9 u1: Deg. F st: NotStopd t0: [16:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [17:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [17:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [17:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [17:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [17:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [17:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 7.5 vu: ml t0: [17:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 2.8 vu: ml
t0: [16:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 24/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 24/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 24/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [16:00:00 24/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 24/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 24/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [16:00:00 24/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [16:00:00 24/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd
t0: [17:30:00 24/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.31 rs: Final st: NotStopd t0: [17:30:00 24/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [17:30:00 24/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 31 rs: Final st: NotStopd t0: [17:30:00 24/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 58 u1: mmHg rs: Final st: NotStopd t0: [17:30:00 24/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 113 u1: mmHg rs: Final st: NotStopd t0: [17:30:00 24/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.31 rs: Final st: NotStopd
t0: [18:00:00 24/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 140 rs: Manual st: NotStopd
tf: [21:00:00 26/02/2016] pt: Unit Dose rt: IV fr: Q2H:PRN m1: Lorazepam v1: 0.5-2 u1: mg
t0: [17:00:00 24/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [17:00:00 24/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [17:30:00 24/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 5.8 rs: Final st: NotStopd t0: [17:30:00 24/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 5.8 rs: Final st: NotStopd t0: [18:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 24/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [18:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 24/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 24/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [18:00:00 24/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 24/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [18:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [18:00:00 24/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [18:00:00 24/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 24/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [18:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [18:00:00 24/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 24/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 24/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [18:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 3.75 vu: ml t0: [18:00:00 24/01/2016] id: paracentesis el: 1 cu: MICU cg: RN vo: 1100 vu: ml t0: [18:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml
t0: [18:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip
tf: [18:00:00 25/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 19 dn: 1 m1: Albumin 25% (12.5gm) v1: 25 u1: gm
t0: [19:36:00 24/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [19:36:00 24/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [19:36:00 24/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [19:36:00 24/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [19:36:00 24/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [19:36:00 24/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [19:36:00 24/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [19:36:00 24/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5.5 st: NotStopd t0: [19:36:00 24/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [19:36:00 24/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [19:36:00 24/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [19:36:00 24/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.79 u1: L/min st: NotStopd t0: [19:36:00 24/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [19:36:00 24/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [19:36:00 24/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [19:36:00 24/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [19:36:00 24/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [19:36:00 24/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [19:36:00 24/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [19:36:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [19:36:00 24/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [19:36:00 24/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [19:36:00 24/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [19:36:00 24/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [19:36:00 24/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 313 u1: ml/B st: NotStopd t0: [19:36:00 24/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [19:36:00 24/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [19:36:00 24/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: SQUARE st: NotStopd
t0: [22:30:00 24/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.33 rs: Final st: NotStopd t0: [22:30:00 24/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 0 rs: Final st: NotStopd t0: [22:30:00 24/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 29 rs: Final st: NotStopd t0: [22:30:00 24/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 53 u1: mmHg rs: Final st: NotStopd t0: [22:30:00 24/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 107 u1: mmHg rs: Final st: NotStopd t0: [22:30:00 24/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.33 rs: Final st: NotStopd
t0: [23:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: -1 ai: 354 vo: 0 st: D/C'd
id: Albumin 25% el: 1 cu: MICU cg: RN io: Albumin 25% Tube Feeding du: ml rt: Intravenous Push
t0: [19:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [19:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [19:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [19:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [19:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [20:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [20:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [20:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [20:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 24/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [21:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 24/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 24/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/O2 Issues st: NotStopd t0: [21:00:00 24/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [21:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 24/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [21:00:00 24/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [21:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 24/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [21:00:00 24/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 24/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [21:00:00 24/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [21:00:00 24/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [21:00:00 24/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [21:00:00 24/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [21:00:00 24/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 24/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [21:00:00 24/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [21:00:00 24/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [21:00:00 24/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [21:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 24/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 24/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [21:00:00 24/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 24/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [21:00:00 24/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 24/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [21:00:00 24/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [21:00:00 24/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 24/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [21:00:00 24/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [21:00:00 24/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 24/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [21:00:00 24/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [21:00:00 24/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [21:00:00 24/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [21:00:00 24/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [21:00:00 24/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 24/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 24/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [21:00:00 24/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [21:00:00 24/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [21:00:00 24/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 24/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [21:00:00 24/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [21:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [21:00:00 24/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [21:00:00 24/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [21:00:00 24/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [21:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 24/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [21:00:00 24/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [21:00:00 24/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [21:00:00 24/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 24/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 24/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [21:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 13 u1: BPM st: NotStopd t0: [21:00:00 24/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [21:00:00 24/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 24/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 24/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 24/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [21:00:00 24/01/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [21:00:00 24/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [21:00:00 24/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [21:00:00 24/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [21:00:00 24/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [21:00:00 24/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [21:00:00 24/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [21:00:00 24/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [21:00:00 24/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 24/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 24/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [22:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [22:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [22:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [22:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [22:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [22:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 24/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 24/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 24/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 24/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 24/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 24/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [23:00:00 24/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 24/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [23:00:00 24/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [23:00:00 24/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 24/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [23:00:00 24/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [23:00:00 24/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [19:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vo: 3.75 vu: ml t0: [19:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml t0: [20:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [20:00:00 24/01/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 354 vu: ml st: Stopped t0: [20:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml t0: [21:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [21:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml t0: [22:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [22:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml t0: [23:00:00 24/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [23:00:00 24/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml
t0: [19:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 24/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 25/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 25/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 25/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/O2 Issues st: NotStopd t0: [00:00:00 25/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 25/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [00:00:00 25/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [00:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 25/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 25/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 25/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [00:00:00 25/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 25/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 25/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [00:00:00 25/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 25/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 25/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [00:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 25/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 25/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 25/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 25/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 25/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 25/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [00:00:00 25/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [00:00:00 25/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 25/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [00:00:00 25/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 25/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 25/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 25/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 25/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [00:00:00 25/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [00:00:00 25/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [00:00:00 25/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 25/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [00:00:00 25/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [00:00:00 25/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [00:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 25/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [00:00:00 25/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 25/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [00:00:00 25/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 25/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 25/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [00:00:00 25/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [00:00:00 25/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 25/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 25/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 25/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [00:00:00 25/01/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 25/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 25/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 25/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2778 u1: Deg. C st: NotStopd t0: [00:00:00 25/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.1 u1: Deg. F st: NotStopd t0: [00:00:00 25/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [00:00:00 25/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [00:00:00 25/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 25/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 25/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 146 rs: Manual st: NotStopd t0: [00:00:00 25/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [22:00:00 24/01/2016] tf: [16:00:00 25/01/2016] dt: 1080 id: Albumin 25% Tube Feeding el: 1 cu: MICU cg: RN ai: -1 vo: 50 vu: ml t0: [23:00:00 24/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: MICU cg: RN ai: -1 vo: 50 vu: ml t0: [00:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [00:00:00 25/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml
t0: [00:00:00 25/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 24/01/2016] dt: 24 id: Colloids Total el: 2 cu: MICU cg: RN pv: 50 cv: 100 ap: none
tf: [10:00:00 26/01/2016] pt: IV Piggyback rt: IV fr: Q8H fs: 0, 8, 16 dn: 3 m1: Bumetanide v1: 2 u1: mg m2: D5W v2: 100 u2: ml tf: [14:00:00 28/01/2016] pt: IV Piggyback rt: IV fr: Q24H fs: 14 dn: 1 m1: Bumetanide v1: 2 u1: mg m2: D5W v2: 100 u2: ml
t0: [00:36:00 25/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:36:00 25/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:36:00 25/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:36:00 25/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [00:36:00 25/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [00:36:00 25/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:36:00 25/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:36:00 25/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [00:36:00 25/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:36:00 25/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7.5 st: NotStopd t0: [00:36:00 25/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:36:00 25/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:36:00 25/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [00:36:00 25/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.42 u1: L/min st: NotStopd t0: [00:36:00 25/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:36:00 25/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:36:00 25/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [00:36:00 25/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [00:36:00 25/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [00:36:00 25/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [00:36:00 25/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:36:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [00:36:00 25/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [00:36:00 25/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [00:36:00 25/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [00:36:00 25/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [00:36:00 25/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [00:36:00 25/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [00:36:00 25/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 287 u1: ml/B st: NotStopd t0: [00:36:00 25/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:36:00 25/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:36:00 25/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:36:00 25/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:36:00 25/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [00:36:00 25/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:36:00 25/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
tf: [00:00:00 26/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 1 dn: 1 m1: Bumetanide v1: 2 u1: mg m2: D5W v2: 50 u2: ml tf: [00:00:00 26/01/2016] pt: Unit Dose rt: PO fr: ONCE fs: 1 dn: 1 m1: Metolazone v1: 2.5 u1: mg
t0: [01:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [01:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [01:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [01:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [01:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [01:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [02:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [02:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [02:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [02:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [03:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [03:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [03:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [03:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [03:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 25/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 25/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 25/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [04:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [04:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [04:00:00 25/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [04:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [04:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [04:00:00 25/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 25/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2778 u1: Deg. C st: NotStopd t0: [04:00:00 25/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.1 u1: Deg. F st: NotStopd t0: [04:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [01:00:00 25/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml t0: [02:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [02:00:00 25/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml t0: [03:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [03:00:00 25/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml t0: [04:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [04:00:00 25/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml
t0: [01:00:00 25/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [02:00:00 25/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 25/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 25/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 25/01/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 70 ap: none
t0: [04:00:00 25/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 25/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [04:00:00 25/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [04:00:00 25/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 25/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 25/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 25/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [04:00:00 25/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 25/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 25/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [04:00:00 25/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 25/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 25/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 25/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 25/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 25/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 25/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 25/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [04:00:00 25/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [04:00:00 25/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 25/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Firm Distended st: NotStopd t0: [04:00:00 25/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 25/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [04:00:00 25/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 25/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 25/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 25/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 25/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 25/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [04:00:00 25/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [04:00:00 25/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [04:00:00 25/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 25/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Diff to Palpate v2: Diff to Palpate st: NotStopd t0: [04:00:00 25/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 25/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [04:00:00 25/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 25/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 25/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 25/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [04:00:00 25/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 25/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 25/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 25/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [04:00:00 25/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [04:00:00 25/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 25/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [04:00:00 25/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 25/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 25/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [04:22:00 25/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd t0: [04:22:00 25/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [04:22:00 25/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [04:22:00 25/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 57 u1: mmHg rs: Final st: NotStopd t0: [04:22:00 25/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 112 u1: mmHg rs: Final st: NotStopd t0: [04:22:00 25/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.35 rs: Final st: NotStopd
t0: [04:00:00 25/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 22.4 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 22.4 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 28.4 u1: % rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8.3 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 499 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.92 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 22.4 rs: Final st: NotStopd
t0: [04:00:00 25/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 16.1 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 43.4 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 16.1 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 43.4 rs: Final st: NotStopd
t0: [05:25:00 25/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [05:25:00 25/01/2016] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 200 u1: units st: NotStopd t0: [05:25:00 25/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [05:25:00 25/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [05:25:00 25/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [05:25:00 25/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [05:25:00 25/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [05:25:00 25/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [05:25:00 25/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [05:25:00 25/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:25:00 25/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7.5 st: NotStopd t0: [05:25:00 25/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:25:00 25/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:25:00 25/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [05:25:00 25/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [05:25:00 25/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:25:00 25/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:25:00 25/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [05:25:00 25/01/2016] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 200 u1: units st: NotStopd t0: [05:25:00 25/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 4 u1: BPM st: NotStopd t0: [05:25:00 25/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [05:25:00 25/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [05:25:00 25/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [05:25:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [05:25:00 25/01/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [05:25:00 25/01/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.15 u1: L st: NotStopd t0: [05:25:00 25/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thin st: NotStopd t0: [05:25:00 25/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [05:25:00 25/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [05:25:00 25/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [05:25:00 25/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [05:25:00 25/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [05:25:00 25/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 338 u1: ml/B st: NotStopd t0: [05:25:00 25/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [05:25:00 25/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [05:25:00 25/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [05:25:00 25/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [05:25:00 25/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [05:25:00 25/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [05:25:00 25/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 25/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 78 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.6 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 128 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 5.3 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 5.9 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 78 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.6 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 128 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 5.3 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 5.9 rs: Final st: NotStopd t0: [04:00:00 25/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
t0: [05:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [05:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [05:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [05:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [05:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 25/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vo: 1.4 vu: ml
t0: [04:00:00 25/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 25/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 25/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 25/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [04:00:00 25/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [04:00:00 25/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Laceration st: NotStopd t0: [04:00:00 25/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: Serous v2: Small st: NotStopd t0: [04:00:00 25/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 25/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [04:00:00 25/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 25/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 25/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 25/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 25/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 25/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 25/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 25/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 25/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 25/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Diaphoretic st: NotStopd t0: [04:00:00 25/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 25/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 25/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 25/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 25/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 25/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [04:00:00 25/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [04:00:00 25/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 11 u1: number st: NotStopd t0: [04:00:00 25/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [06:00:00 25/01/2016] id: INV Line#2 D/C Date el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [06:00:00 25/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Right IJ st: NotStopd t0: [06:00:00 25/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 20 st: NotStopd t0: [06:00:00 25/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd
t0: [06:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [06:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [06:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [06:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [06:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml st: Stopped t0: [06:00:00 25/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: RN ai: 416 vu: ml st: Stopped
t0: [05:00:00 25/01/2016] id: Fentanyl el: 1 cu: MICU cg: RN so: .9% Normal Saline vo: 0 v1: 70 du: mcghr sv: 50 su: ml rt: IV Drip st: Stopped
t0: [23:00:00 25/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 708.4 ap: none t0: [23:00:00 25/01/2016] dt: 24 id: IV Nutrition Total el: 2 cu: MICU cg: RN pv: 59.6 cv: 715.2 ap: none t0: [23:00:00 25/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 69.6 cv: 1563.6 ap: none
t0: [07:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [07:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [07:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [07:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [07:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [07:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 25/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 25/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [08:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 25/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 25/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 25/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 25/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [08:00:00 25/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 25/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 25/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [08:00:00 25/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 25/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 25/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [08:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 25/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 25/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 25/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 25/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 25/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 25/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Laceration st: NotStopd t0: [08:00:00 25/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: Serous v2: Small st: NotStopd t0: [08:00:00 25/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 25/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [08:00:00 25/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [08:00:00 25/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 25/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 25/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 25/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 25/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 25/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 25/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 4 Flex-withdraws st: NotStopd t0: [08:00:00 25/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [08:00:00 25/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 25/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [08:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [08:00:00 25/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 25/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [08:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 25/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 25/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 25/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [08:00:00 25/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [08:00:00 25/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [08:00:00 25/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 25/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 25/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 25/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [08:00:00 25/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 25/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 25/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [08:00:00 25/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 25/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 25/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 25/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 25/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 25/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 25/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 25/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 25/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 25/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Moist st: NotStopd t0: [08:00:00 25/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [08:00:00 25/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 11 u1: number st: NotStopd t0: [08:00:00 25/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [23:00:00 25/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 190 cv: 190 ap: none t0: [23:00:00 25/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -120.4 cv: -120.4 ap: none t0: [23:00:00 25/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 190 cv: 4135 ap: none t0: [23:00:00 25/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -120.4 cv: -2571.4 ap: none t0: [23:00:00 25/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 190 cv: 4135 ap: none t0: [23:00:00 25/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -120.4 cv: 14002.8 ap: carryForward
t0: [07:00:00 25/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [07:00:00 25/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [07:00:00 25/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [07:00:00 25/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [07:00:00 25/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [07:00:00 25/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:00:00 25/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:00:00 25/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7.5 st: NotStopd t0: [07:00:00 25/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:00:00 25/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:00:00 25/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [07:00:00 25/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.2 u1: L/min st: NotStopd t0: [07:00:00 25/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:00:00 25/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [07:00:00 25/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [07:00:00 25/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [07:00:00 25/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [07:00:00 25/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [07:00:00 25/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [07:00:00 25/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [07:00:00 25/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [07:00:00 25/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [07:00:00 25/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [07:00:00 25/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 330 u1: ml/B st: NotStopd t0: [07:00:00 25/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [07:00:00 25/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [07:00:00 25/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 25/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 25/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 25/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 25/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [08:00:00 25/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [10:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [10:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [10:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [10:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [10:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 25/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:00:00 25/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [11:00:00 25/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [11:00:00 25/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [11:00:00 25/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:00:00 25/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 25/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:00:00 25/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7.5 st: NotStopd t0: [11:00:00 25/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:00:00 25/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:00:00 25/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [11:00:00 25/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.9 u1: L/min st: NotStopd t0: [11:00:00 25/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 25/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 25/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [11:00:00 25/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [11:00:00 25/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [11:00:00 25/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [11:00:00 25/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [11:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [11:00:00 25/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [11:00:00 25/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [11:00:00 25/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [11:00:00 25/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 11 st: NotStopd t0: [11:00:00 25/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [11:00:00 25/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [11:00:00 25/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [11:00:00 25/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [11:00:00 25/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [11:00:00 25/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd
t0: [11:00:00 25/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [11:00:00 25/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [11:00:00 25/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [11:00:00 25/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 25/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 25/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [11:00:00 25/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Laceration st: NotStopd t0: [11:00:00 25/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: Serous v2: Small st: NotStopd t0: [11:00:00 25/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [11:00:00 25/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [11:00:00 25/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [11:00:00 25/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [11:00:00 25/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [11:00:00 25/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 25/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [11:00:00 25/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [11:00:00 25/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 25/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 25/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 25/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [11:00:00 25/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 25/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 25/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [11:00:00 25/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [11:00:00 25/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 25/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd
t0: [12:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 25/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 25/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 25/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 25/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [12:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 25/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 25/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 25/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 25/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 25/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 25/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Bilious st: NotStopd t0: [12:00:00 25/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 25/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [12:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 25/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 25/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 25/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [12:00:00 25/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [12:00:00 25/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 25/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 25/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [12:00:00 25/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 169 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [12:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 120 u1: mmHg st: NotStopd t0: [12:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 25/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [12:00:00 25/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [12:00:00 25/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 25/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 25/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [12:00:00 25/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 25/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 25/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 25/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [12:00:00 25/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 25/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [12:00:00 25/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [12:00:00 25/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 25/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 25/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
pt: TPN
t0: [12:00:00 25/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 113 rs: Manual st: NotStopd
t0: [13:00:00 25/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [13:00:00 25/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [14:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [14:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [14:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [14:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [14:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [14:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 25/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 25/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 25/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 25/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 25/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [16:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 25/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 25/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 25/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [16:00:00 25/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 25/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 25/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 25/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [16:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 25/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 25/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [16:00:00 25/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [16:00:00 25/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 25/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [16:00:00 25/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [16:00:00 25/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 25/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 25/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 25/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 25/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 25/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Laceration st: NotStopd t0: [16:00:00 25/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: Serous v2: Small st: NotStopd t0: [16:00:00 25/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 25/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Dry Sterile Dsg st: NotStopd t0: [16:00:00 25/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [16:00:00 25/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [16:00:00 25/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 25/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 25/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 25/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 25/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [16:00:00 25/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [16:00:00 25/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 25/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 25/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [16:00:00 25/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 25/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [16:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [16:00:00 25/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 25/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 25/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [16:00:00 25/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [16:00:00 25/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [16:00:00 25/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 25/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 25/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [16:00:00 25/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 25/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 25/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 25/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Diaphoretic st: NotStopd t0: [16:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 25/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [16:00:00 25/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 25/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [16:00:00 25/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 25/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [16:00:00 25/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [16:00:00 25/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [16:00:00 25/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [16:00:00 25/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 25/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 25/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 25/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 25/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: Done t0: [16:00:00 25/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [16:00:00 25/01/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 1 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd t0: [16:00:00 25/01/2016] id: Albumin 25% Tube Feeding el: 1 cu: MICU cg: -1 ai: -1 vo: 0 st: D/C'd t0: [16:00:00 25/01/2016] id: .9% Normal Saline 100.0ml + 5000mcghr Fentanyl IV Infusions el: 1 cu: MICU cg: -1 ai: 416 vo: 0 st: D/C'd
t0: [16:00:00 25/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:00:00 25/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:00:00 25/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 25/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:00:00 25/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [16:00:00 25/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 25/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 25/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 25/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 25/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7.5 st: NotStopd t0: [16:00:00 25/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 25/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 25/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [16:00:00 25/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.1 u1: L/min st: NotStopd t0: [16:00:00 25/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 25/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 25/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [16:00:00 25/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [16:00:00 25/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [16:00:00 25/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [16:00:00 25/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:00:00 25/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.1 st: NotStopd t0: [16:00:00 25/01/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [16:00:00 25/01/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: RRT v1: 0.6 u1: sec st: NotStopd t0: [16:00:00 25/01/2016] id: TCPCV-MAP el: 0 cu: MICU cg: RRT v1: 12 st: NotStopd t0: [16:00:00 25/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 280 u1: ml/B st: NotStopd t0: [16:00:00 25/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:00:00 25/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:00:00 25/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:00:00 25/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:00:00 25/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Pressure Control st: NotStopd t0: [16:00:00 25/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 25/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [16:00:00 25/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml nb: 1
t0: [17:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 0 vu: ml nb: 1
t0: [17:30:00 25/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [17:30:00 25/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 6.1 u1: L/min st: NotStopd t0: [17:30:00 25/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:30:00 25/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [17:30:00 25/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 23 u1: BPM st: NotStopd t0: [17:30:00 25/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [17:30:00 25/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd
t0: [18:00:00 25/01/2016] tf: [09:00:00 27/01/2016] dt: 2340 id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [18:00:00 25/01/2016] tf: [20:00:00 28/01/2016] dt: 4440 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 20 vu: ml
t0: [18:00:00 25/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 131 rs: Manual st: NotStopd
t0: [18:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 25/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [18:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [18:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 25/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 25/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 25/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [18:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [18:00:00 25/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [18:00:00 25/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 25/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [18:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [18:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 25/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [18:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
tf: [10:00:00 13/02/2016] pt: Unit Dose rt: IV fr: Q2H:PRN m1: Fentanyl Citrate v1: 12.5-25 u1: mcg
t0: [20:00:00 25/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 25/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 25/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 25/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [20:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 25/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 25/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 25/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 25/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 25/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 25/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [20:00:00 25/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 25/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 25/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 25/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 25/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [20:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 25/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 25/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [20:00:00 25/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [20:00:00 25/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 25/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [20:00:00 25/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [20:00:00 25/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 25/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 25/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 25/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [20:00:00 25/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [20:00:00 25/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 25/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 25/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 25/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 25/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [20:00:00 25/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 25/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [20:00:00 25/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 25/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [20:00:00 25/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [20:00:00 25/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 25/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 25/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 25/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [20:00:00 25/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 25/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 25/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [20:00:00 25/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 25/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 25/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [20:00:00 25/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [20:00:00 25/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 25/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [20:00:00 25/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 25/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 25/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 25/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 25/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 25/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 25/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [20:00:00 25/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 20 vu: ml
t0: [20:15:00 25/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:15:00 25/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:15:00 25/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:15:00 25/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:15:00 25/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [20:15:00 25/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:15:00 25/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:15:00 25/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:15:00 25/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:15:00 25/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:15:00 25/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.3 u1: L/min st: NotStopd t0: [20:15:00 25/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:15:00 25/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:15:00 25/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [20:15:00 25/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [20:15:00 25/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:15:00 25/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [20:15:00 25/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [20:15:00 25/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:15:00 25/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:15:00 25/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:15:00 25/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:15:00 25/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:15:00 25/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [21:00:00 25/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
tf: [21:00:00 28/01/2016] pt: Unit Dose rt: NU fr: BID fs: 10, 22 dn: 2 m1: Oxymetazoline HCl v1: 1 u1: SPRY
t0: [22:00:00 25/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 25/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 25/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [22:00:00 25/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 25/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 25/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 25/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 105 u1: BPM st: NotStopd t0: [22:00:00 25/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [22:00:00 25/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 165 u1: mmHg v2: 98 u2: mmHg st: NotStopd t0: [22:00:00 25/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 122 u1: mmHg st: NotStopd t0: [22:00:00 25/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 25/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [22:00:00 25/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [22:00:00 25/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [23:00:00 25/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [23:00:00 25/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [23:00:00 25/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 10 cv: 70 ap: none
t0: [20:00:00 25/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [20:00:00 25/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [00:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 26/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [00:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 26/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [00:00:00 26/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [00:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [00:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [00:00:00 26/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [00:00:00 26/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [00:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 26/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 149 rs: Manual st: NotStopd
t0: [00:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [00:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [01:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [01:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [23:00:00 26/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 550 ap: none
t0: [01:00:00 26/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [01:00:00 26/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [01:00:00 26/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [01:00:00 26/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [01:00:00 26/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [01:00:00 26/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [01:00:00 26/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [01:00:00 26/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:00:00 26/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 26/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [01:00:00 26/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.8 u1: L/min st: NotStopd t0: [01:00:00 26/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 26/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 26/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [01:00:00 26/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [01:00:00 26/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [01:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [01:00:00 26/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 395 u1: ml/B st: NotStopd t0: [01:00:00 26/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [01:00:00 26/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [01:00:00 26/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [01:00:00 26/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [01:00:00 26/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [01:00:00 26/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [02:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 26/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [02:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 26/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [02:00:00 26/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [02:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [02:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [02:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [03:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [03:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [23:00:00 26/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 300 cv: 300 ap: none t0: [23:00:00 26/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -210.4 cv: -210.4 ap: none t0: [23:00:00 26/01/2016] dt: 24 id: IV Nutrition Total el: 2 cu: MICU cg: RN pv: 59.6 cv: 1430.4 ap: none t0: [23:00:00 26/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 89.6 cv: 2430.4 ap: none t0: [23:00:00 26/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 30 cv: 430 ap: none t0: [23:00:00 26/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 300 cv: 5480 ap: none t0: [23:00:00 26/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -210.4 cv: -3049.6 ap: none t0: [23:00:00 26/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 300 cv: 5480 ap: none t0: [23:00:00 26/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -210.4 cv: 10953.1 ap: carryForward
t0: [04:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [04:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 26/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 177 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [04:00:00 26/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 120 u1: mmHg st: NotStopd t0: [04:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [04:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [04:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [04:00:00 26/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 26/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [04:00:00 26/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd
t0: [04:09:00 26/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.4 rs: Final st: NotStopd t0: [04:09:00 26/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 5 rs: Final st: NotStopd t0: [04:09:00 26/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [04:09:00 26/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 50 u1: mmHg rs: Final st: NotStopd t0: [04:09:00 26/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 112 u1: mmHg rs: Final st: NotStopd t0: [04:09:00 26/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.4 rs: Final st: NotStopd
t0: [04:00:00 26/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 21.9 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 21.9 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 27 u1: % rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8.4 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 484 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.8 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 21.9 rs: Final st: NotStopd
t0: [05:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [05:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [00:00:00 26/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 26/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 26/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [00:00:00 26/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 26/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 26/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [00:00:00 26/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 26/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 26/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [00:00:00 26/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 26/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 26/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 26/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 26/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [00:00:00 26/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [00:00:00 26/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 26/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [00:00:00 26/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [00:00:00 26/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 26/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 26/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [00:00:00 26/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 26/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 26/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [00:00:00 26/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [00:00:00 26/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 26/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 26/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 26/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 26/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 26/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 26/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [00:00:00 26/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 26/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 26/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 26/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 26/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 26/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [00:00:00 26/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [00:00:00 26/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [00:00:00 26/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 26/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 26/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 26/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 26/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 26/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 26/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [00:00:00 26/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 26/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 26/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 26/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 26/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 26/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 26/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 26/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 26/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [00:00:00 26/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 26/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 26/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 26/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 26/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 26/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [00:00:00 26/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 26/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 26/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 26/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 26/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [04:00:00 26/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 26/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 26/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [04:00:00 26/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 26/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 26/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [04:00:00 26/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 26/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 26/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 26/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 26/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [04:00:00 26/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [04:00:00 26/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 26/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [04:00:00 26/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [04:00:00 26/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 26/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 26/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [04:00:00 26/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 26/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 26/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [04:00:00 26/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 26/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 26/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 26/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 26/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 26/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Lethargic st: NotStopd t0: [04:00:00 26/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 26/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [04:00:00 26/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 26/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 26/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 26/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 26/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 26/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 26/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Sluggish v2: Sluggish st: NotStopd t0: [04:00:00 26/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [04:00:00 26/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 26/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 26/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 26/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 26/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 26/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 26/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [04:00:00 26/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [04:00:00 26/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [04:00:00 26/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 26/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [04:00:00 26/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 26/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 26/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 26/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 26/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 26/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [04:00:00 26/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd
t0: [04:00:00 26/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 43.3 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 43.3 rs: Final st: NotStopd
t0: [04:00:00 26/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 84 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.9 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 145 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.8 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 5.4 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 84 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.9 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 145 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.8 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 5.4 rs: Final st: NotStopd t0: [04:00:00 26/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd
t0: [06:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [06:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 26/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [06:00:00 26/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [06:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [06:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [06:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [06:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [05:00:00 26/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [05:00:00 26/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [05:00:00 26/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [05:00:00 26/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [05:00:00 26/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [05:00:00 26/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [05:00:00 26/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [05:00:00 26/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:00:00 26/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 26/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [05:00:00 26/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.5 u1: L/min st: NotStopd t0: [05:00:00 26/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 26/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 26/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [05:00:00 26/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [05:00:00 26/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [05:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [05:00:00 26/01/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [05:00:00 26/01/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.083 u1: L st: NotStopd t0: [05:00:00 26/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 359 u1: ml/B st: NotStopd t0: [05:00:00 26/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [05:00:00 26/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [05:00:00 26/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [05:00:00 26/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [05:00:00 26/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [05:00:00 26/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [07:00:00 26/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [07:00:00 26/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [07:00:00 26/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [07:00:00 26/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [07:00:00 26/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [07:00:00 26/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [07:00:00 26/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [07:00:00 26/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:00:00 26/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:00:00 26/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [07:00:00 26/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:00:00 26/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:00:00 26/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.5 u1: L/min st: NotStopd t0: [07:00:00 26/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:00:00 26/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [07:00:00 26/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [07:00:00 26/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [07:00:00 26/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [07:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [07:00:00 26/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 315 u1: ml/B st: NotStopd t0: [07:00:00 26/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [07:00:00 26/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [07:00:00 26/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [07:00:00 26/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [07:00:00 26/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [07:00:00 26/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 26/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 26/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 26/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 26/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 26/01/2016] id: Readmit <48 hrs el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 26/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [08:00:00 26/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 26/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 26/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 26/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 26/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 26/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [08:00:00 26/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 26/01/2016] id: GI Guaiac/ph el: 0 cu: MICU cg: RN v1: Negative v2: 6 st: NotStopd t0: [08:00:00 26/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 26/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 26/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Bilious st: NotStopd t0: [08:00:00 26/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 26/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 26/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [08:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 26/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 26/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [08:00:00 26/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 26/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [08:00:00 26/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 26/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [08:00:00 26/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [08:00:00 26/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 26/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 26/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [08:00:00 26/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 26/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [08:00:00 26/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [08:00:00 26/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 26/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 26/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [08:00:00 26/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 26/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Approximated st: NotStopd t0: [08:00:00 26/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Approximated st: NotStopd t0: [08:00:00 26/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 26/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 26/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 26/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 26/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 26/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 26/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 26/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 26/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Lethargic st: NotStopd t0: [08:00:00 26/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 26/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [08:00:00 26/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 26/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 26/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [08:00:00 26/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 26/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [08:00:00 26/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 26/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 26/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [08:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 26/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [08:00:00 26/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 26/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 5 mm v2: 5 mm st: NotStopd t0: [08:00:00 26/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 26/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 26/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [08:00:00 26/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 26/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 26/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 26/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 26/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [08:00:00 26/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [08:00:00 26/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 26/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [08:00:00 26/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 26/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Rectal st: NotStopd t0: [08:00:00 26/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.9444 u1: Deg. C st: NotStopd t0: [08:00:00 26/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.5 u1: Deg. F st: NotStopd t0: [08:00:00 26/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 26/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 26/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 26/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 26/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [08:00:00 26/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 26/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 26/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 26/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 26/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 26/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [08:00:00 26/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 10 u1: number st: NotStopd t0: [08:00:00 26/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Comp. Limited st: NotStopd
t0: [08:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [08:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 20 vu: ml
tf: [09:00:00 27/01/2016] pt: Unit Dose rt: IV fr: QD fs: 10 dn: 1 m1: Bumetanide v1: 2 u1: mg tf: [09:00:00 29/01/2016] pt: Unit Dose rt: SC fr: QD fs: 10 dn: 1 m1: Phytonadione v1: 10 u1: mg
t0: [09:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [09:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 26/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 163 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [09:00:00 26/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 112 u1: mmHg st: NotStopd t0: [09:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [09:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [09:00:00 26/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [09:00:00 26/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [09:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 26/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 26/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [10:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 26/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 26/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [10:00:00 26/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 26/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 26/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 182 u1: mmHg v2: 92 u2: mmHg st: NotStopd t0: [10:00:00 26/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 126 u1: mmHg st: NotStopd t0: [10:00:00 26/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [10:00:00 26/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [10:00:00 26/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 26/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [10:00:00 26/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 26/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: done
t0: [09:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [09:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml t0: [10:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [10:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [11:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [11:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 26/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 166 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [11:00:00 26/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [11:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [11:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [11:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 10 vu: ml
t0: [11:00:00 26/01/2016] id: Procedures el: 0 cu: MICU cg: RN v1: Ultrasound st: NotStopd
t0: [11:00:00 26/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [11:00:00 26/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [11:00:00 26/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:00:00 26/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [11:00:00 26/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [11:00:00 26/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [11:00:00 26/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:00:00 26/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 26/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:00:00 26/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [11:00:00 26/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:00:00 26/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:00:00 26/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.6 u1: L/min st: NotStopd t0: [11:00:00 26/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 26/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 26/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [11:00:00 26/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [11:00:00 26/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [11:00:00 26/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [11:00:00 26/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [11:00:00 26/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [11:00:00 26/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [11:00:00 26/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [11:00:00 26/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [11:00:00 26/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
pt: TPN
t0: [12:00:00 26/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 26/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [12:00:00 26/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 26/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 26/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [12:00:00 26/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 26/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 26/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 26/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [12:00:00 26/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [12:00:00 26/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 26/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 26/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Bilious st: NotStopd t0: [12:00:00 26/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [12:00:00 26/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 26/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [12:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 26/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 26/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [12:00:00 26/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 26/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [12:00:00 26/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 26/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [12:00:00 26/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [12:00:00 26/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 26/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 26/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: RN v1: Sharp st: NotStopd t0: [12:00:00 26/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 26/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [12:00:00 26/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 26/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [12:00:00 26/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [12:00:00 26/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 26/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 26/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 26/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 26/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 26/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 26/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [12:00:00 26/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 26/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 26/01/2016] id: Arterial BP el: 0 cu: MICU cg: RN v1: 170 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [12:00:00 26/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 26/01/2016] id: Arterial BP Mean el: 0 cu: MICU cg: RN v1: 117 u1: mmHg st: NotStopd t0: [12:00:00 26/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [12:00:00 26/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 26/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [12:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 26/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [12:00:00 26/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [12:00:00 26/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [12:00:00 26/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 26/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 26/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [12:00:00 26/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 26/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 26/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 26/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 26/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [12:00:00 26/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [12:00:00 26/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [12:00:00 26/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 26/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [12:00:00 26/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 26/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 26/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [12:00:00 26/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [12:00:00 26/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [12:00:00 26/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 26/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 26/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 26/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [12:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [12:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 20 vu: ml
t0: [14:00:00 26/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [14:00:00 26/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd
t0: [13:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [13:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [13:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [13:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [14:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [14:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [14:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [13:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 20 vu: ml
t0: [13:00:00 26/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [13:00:00 26/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [13:00:00 26/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 26/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [13:00:00 26/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [13:00:00 26/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [13:00:00 26/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [14:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [14:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 20 vu: ml
t0: [15:00:00 26/01/2016] id: INV Line#1 Zero/Cal el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 26/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 26/01/2016] id: INV#1 WaveformAppear el: 0 cu: MICU cg: -1 st: D/C'd
t0: [15:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [15:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 26/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [15:00:00 26/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [15:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [15:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [15:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [16:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [15:00:00 26/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 26/01/2016] id: INV Line#1 D/C Date el: 0 cu: MICU cg: RN v1: 1 v2: 27 st: NotStopd t0: [15:00:00 26/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: A-Line v2: Left Radial st: NotStopd t0: [15:00:00 26/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 8 st: NotStopd t0: [15:00:00 26/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [15:00:00 26/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [15:00:00 26/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [15:00:00 26/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 26/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [15:00:00 26/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 26/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [15:00:00 26/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Total Lift st: NotStopd t0: [15:00:00 26/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [15:00:00 26/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd
t0: [16:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 26/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 26/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [16:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 26/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [16:00:00 26/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.6667 u1: mmHg st: NotStopd t0: [16:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [16:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 26/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:00:00 26/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:00:00 26/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 26/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:00:00 26/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [16:00:00 26/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 26/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 26/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 26/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 26/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 26/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 26/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 26/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [16:00:00 26/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.6 u1: L/min st: NotStopd t0: [16:00:00 26/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 26/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 26/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [16:00:00 26/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [16:00:00 26/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [16:00:00 26/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [16:00:00 26/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [16:00:00 26/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [16:00:00 26/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [16:00:00 26/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [16:00:00 26/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:00:00 26/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:00:00 26/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:00:00 26/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:00:00 26/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:00:00 26/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 26/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [16:00:00 26/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 26/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [16:00:00 26/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 26/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 26/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 26/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [16:00:00 26/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 26/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 26/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 26/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 26/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [16:00:00 26/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 26/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 26/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 26/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [16:00:00 26/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [16:00:00 26/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 26/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 26/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 26/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 26/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [16:00:00 26/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 26/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [16:00:00 26/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 26/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 26/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 26/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 26/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 26/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 26/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 26/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 26/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [16:00:00 26/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 26/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [16:00:00 26/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 26/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 26/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [16:00:00 26/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [16:00:00 26/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 26/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 26/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 26/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [17:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [17:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 26/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [17:00:00 26/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [17:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [17:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 76 u1: % st: NotStopd t0: [17:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [18:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 26/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [18:00:00 26/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.6667 u1: mmHg st: NotStopd t0: [18:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [18:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [18:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [18:00:00 26/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 26/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 26/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [18:00:00 26/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 26/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 26/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [18:00:00 26/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [18:00:00 26/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [18:00:00 26/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd
t0: [20:00:00 26/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 26/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 26/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 26/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 26/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 26/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 26/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 26/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 26/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [20:00:00 26/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.9 u1: L/min st: NotStopd t0: [20:00:00 26/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 26/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 26/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [20:00:00 26/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 23 u1: BPM st: NotStopd t0: [20:00:00 26/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [20:00:00 26/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [20:00:00 26/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 26/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [20:00:00 26/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 26/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 26/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [19:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [19:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 26/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [19:00:00 26/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.6667 u1: mmHg st: NotStopd t0: [19:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [19:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 26/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 26/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 26/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 26/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 26/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 26/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [20:00:00 26/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 26/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 26/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 26/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [20:00:00 26/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 26/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 26/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [20:00:00 26/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 26/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 26/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 26/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [20:00:00 26/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [20:00:00 26/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 26/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [20:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 26/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 26/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [20:00:00 26/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [20:00:00 26/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 26/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 26/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 26/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [20:00:00 26/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [20:00:00 26/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 26/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 26/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 26/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [20:00:00 26/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 26/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 26/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 26/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Lethargic st: NotStopd t0: [20:00:00 26/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [20:00:00 26/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [20:00:00 26/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77.3333 u1: mmHg st: NotStopd t0: [20:00:00 26/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 26/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [20:00:00 26/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 26/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 26/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 26/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [20:00:00 26/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 26/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 26/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 26/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [20:00:00 26/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 26/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 26/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [20:00:00 26/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 26/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 26/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [20:00:00 26/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [20:00:00 26/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 26/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [20:00:00 26/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Soft st: NotStopd t0: [20:00:00 26/01/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 26/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [20:00:00 26/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 26/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 26/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2778 u1: Deg. C st: NotStopd t0: [20:00:00 26/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.1 u1: Deg. F st: NotStopd t0: [20:00:00 26/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 26/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 26/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 26/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [20:00:00 26/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 26/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 26/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 26/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 26/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [20:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [20:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [23:00:00 26/01/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 20 ap: none
t0: [21:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [21:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 26/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [21:00:00 26/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [21:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [22:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 26/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [22:00:00 26/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.6667 u1: mmHg st: NotStopd t0: [22:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [22:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [21:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml t0: [22:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [22:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml
t0: [23:00:00 26/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 26/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 26/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 26/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 26/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 26/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [23:00:00 26/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 26/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [23:00:00 26/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.3333 u1: mmHg st: NotStopd t0: [23:00:00 26/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 26/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [23:00:00 26/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 26/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 26/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [23:00:00 26/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml
t0: [00:00:00 27/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWker v1: 164 rs: Manual st: NotStopd
t0: [01:00:00 27/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [01:00:00 27/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [01:00:00 27/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [01:00:00 27/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [01:00:00 27/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [01:00:00 27/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [01:00:00 27/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [01:00:00 27/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:00:00 27/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 27/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [01:00:00 27/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [01:00:00 27/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [01:00:00 27/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [01:00:00 27/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.1 u1: L/min st: NotStopd t0: [01:00:00 27/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 27/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 27/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 39 u1: cmH2O st: NotStopd t0: [01:00:00 27/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [01:00:00 27/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [01:00:00 27/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [01:00:00 27/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [01:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [01:00:00 27/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [01:00:00 27/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [01:00:00 27/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [01:00:00 27/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [01:00:00 27/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [01:00:00 27/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [01:00:00 27/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [01:00:00 27/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [01:00:00 27/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [01:00:00 27/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 27/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 27/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 27/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 27/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 27/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [00:00:00 27/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [00:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 27/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [00:00:00 27/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 2 To pain st: NotStopd t0: [00:00:00 27/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [00:00:00 27/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 8 u1: points st: NotStopd t0: [00:00:00 27/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 27/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [00:00:00 27/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [00:00:00 27/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [00:00:00 27/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 27/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [00:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 27/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 27/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [00:00:00 27/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [00:00:00 27/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 27/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 27/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 27/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 27/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [00:00:00 27/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [00:00:00 27/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 27/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [00:00:00 27/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 27/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 27/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 27/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [00:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [00:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.6667 u1: mmHg st: NotStopd t0: [00:00:00 27/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 27/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 27/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 27/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 27/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 27/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 27/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 27/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 27/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [00:00:00 27/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 27/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [00:00:00 27/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 27/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 27/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [00:00:00 27/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 27/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 27/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [00:00:00 27/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [00:00:00 27/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Soft st: NotStopd t0: [00:00:00 27/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 27/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 27/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 27/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [00:00:00 27/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [00:00:00 27/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 27/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 27/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 27/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 27/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [00:00:00 27/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [00:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [01:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [01:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [01:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.3333 u1: mmHg st: NotStopd t0: [01:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [01:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 27/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [02:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [02:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 27/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [02:00:00 27/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [02:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [02:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [02:00:00 27/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [02:00:00 27/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [02:00:00 27/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [02:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 27/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [02:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [02:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 27/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [02:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [03:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 27/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [03:00:00 27/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [03:00:00 27/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [03:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [03:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [03:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [03:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 27/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [03:00:00 27/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [03:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 27/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [01:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [02:00:00 27/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [02:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [23:00:00 27/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 240 cv: 240 ap: none t0: [23:00:00 27/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -165 cv: -165 ap: none t0: [23:00:00 27/01/2016] dt: 24 id: IV Nutrition Total el: 2 cu: MICU cg: RN cv: 536.4 ap: none t0: [23:00:00 27/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 75 cv: 2171.4 ap: none t0: [23:00:00 27/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1285 ap: none t0: [23:00:00 27/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 240 cv: 4395 ap: none t0: [23:00:00 27/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -165 cv: -2223.6 ap: carryForward t0: [23:00:00 27/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 240 cv: 4395 ap: carryForward t0: [23:00:00 27/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -165 cv: 8729.54 ap: carryForward
t0: [05:00:00 27/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWker v1: 159 rs: Manual st: NotStopd
t0: [05:00:00 27/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [05:00:00 27/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [05:00:00 27/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [05:00:00 27/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [05:00:00 27/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [05:00:00 27/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [05:00:00 27/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [05:00:00 27/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:00:00 27/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 27/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [05:00:00 27/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:00:00 27/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:00:00 27/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [05:00:00 27/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.8 u1: L/min st: NotStopd t0: [05:00:00 27/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 27/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 27/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [05:00:00 27/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [05:00:00 27/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [05:00:00 27/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [05:00:00 27/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [05:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [05:00:00 27/01/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 46 u1: BPM st: NotStopd t0: [05:00:00 27/01/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.211 u1: L st: NotStopd t0: [05:00:00 27/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [05:00:00 27/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [05:00:00 27/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [05:00:00 27/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [05:00:00 27/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [05:00:00 27/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [05:00:00 27/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [05:00:00 27/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [05:00:00 27/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [05:00:00 27/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 27/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 27/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 27/01/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 27/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 27/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 27/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 27/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 27/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: TPN st: NotStopd t0: [04:00:00 27/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [04:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 27/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 27/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 27/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Inconsistently st: NotStopd t0: [04:00:00 27/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 9 u1: points st: NotStopd t0: [04:00:00 27/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [04:00:00 27/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [04:00:00 27/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [04:00:00 27/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [04:00:00 27/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 27/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [04:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 27/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 27/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 27/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 27/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 27/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [04:00:00 27/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 27/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 27/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 27/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 27/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [04:00:00 27/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 27/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 27/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 27/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 27/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 27/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 27/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 27/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Lethargic st: NotStopd t0: [04:00:00 27/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 5 Localizes Pain st: NotStopd t0: [04:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [04:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.3333 u1: mmHg st: NotStopd t0: [04:00:00 27/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [04:00:00 27/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 27/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 27/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 27/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 27/01/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 27/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 27/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 27/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 27/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [04:00:00 27/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 27/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 27/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 27/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 27/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [04:00:00 27/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 27/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [04:00:00 27/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 27/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 27/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 27/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 27/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Diaphoretic st: NotStopd t0: [04:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 27/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [04:00:00 27/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [04:00:00 27/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [04:00:00 27/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 27/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 27/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2778 u1: Deg. C st: NotStopd t0: [04:00:00 27/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.1 u1: Deg. F st: NotStopd t0: [04:00:00 27/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 27/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 27/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 27/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 27/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [04:00:00 27/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 27/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 27/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 27/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 27/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [04:00:00 27/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [04:00:00 27/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [05:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [05:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [05:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [05:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [05:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 27/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [03:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [04:00:00 27/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [04:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [05:00:00 27/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [05:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 50 vu: ml
t0: [04:00:00 27/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 19.6 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 19.6 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 28.2 u1: % rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8.3 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 471 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.99 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 19.6 rs: Final st: NotStopd
t0: [04:00:00 27/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 85 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 9.4 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.2 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 85 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 9.4 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.2 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [04:00:00 27/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd
t0: [06:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [06:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [06:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [06:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [06:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 27/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 59.6 vu: ml t0: [06:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [06:00:00 27/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [06:00:00 27/01/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 27/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [06:00:00 27/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [06:00:00 27/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 27/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 27/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 27/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 27/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [06:00:00 27/01/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 27/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [06:00:00 27/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [06:00:00 27/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [06:00:00 27/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 27/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [06:00:00 27/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [06:00:00 27/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [06:00:00 27/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 27/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd
t0: [07:35:00 27/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [07:35:00 27/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [07:35:00 27/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [07:35:00 27/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [07:35:00 27/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [07:35:00 27/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [07:35:00 27/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [07:35:00 27/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:35:00 27/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:35:00 27/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [07:35:00 27/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:35:00 27/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:35:00 27/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [07:35:00 27/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [07:35:00 27/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:35:00 27/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [07:35:00 27/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [07:35:00 27/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 21 u1: BPM st: NotStopd t0: [07:35:00 27/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [07:35:00 27/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [07:35:00 27/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [07:35:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [07:35:00 27/01/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:11 st: NotStopd t0: [07:35:00 27/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [07:35:00 27/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [07:35:00 27/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [07:35:00 27/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [07:35:00 27/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [07:35:00 27/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [07:35:00 27/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [07:35:00 27/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [07:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [07:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [07:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [07:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [07:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
tf: [07:00:00 28/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 8 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml
t0: [08:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 27/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 27/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [08:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 27/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [08:00:00 27/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [08:00:00 27/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 27/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 27/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [08:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.667 u1: mmHg st: NotStopd t0: [08:00:00 27/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 27/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 27/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 27/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 27/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [08:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [08:00:00 27/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [08:00:00 27/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 27/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 27/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 27/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 119.2 vu: ml t0: [08:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 80 vu: ml
t0: [08:00:00 27/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 27/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 27/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 27/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 27/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [08:00:00 27/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 27/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 27/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 27/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 27/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 12 v2: 29 st: NotStopd t0: [08:00:00 27/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 27/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 27/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 27/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 27/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 27/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 27/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 27/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 27/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 27/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [08:00:00 27/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 27/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [08:00:00 27/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 27/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 27/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 27/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 27/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [08:00:00 27/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 27/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [08:00:00 27/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 27/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 27/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 27/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [10:00:00 27/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: -1 ai: -1 vo: 0 st: D/C'd
tf: [10:00:00 13/02/2016] pt: Unit Dose rt: SC fr: ASDIR m1: Insulin v1: 0 u1: UNIT
t0: [08:45:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:45:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:45:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:45:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [08:45:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [08:45:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [08:45:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:45:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [08:45:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:45:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [09:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [09:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [09:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [09:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [10:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [10:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [10:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [10:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 27/01/2016] id: TPN 1000.0ml IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 0 vu: ml t0: [09:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 50 vu: ml t0: [10:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 50 vu: ml
t0: [09:00:00 27/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [09:00:00 27/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [09:00:00 27/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [09:00:00 27/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [09:00:00 27/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [09:00:00 27/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [09:00:00 27/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd
t0: [08:00:00 27/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 27/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Normal Saline st: NotStopd t0: [08:00:00 27/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 27/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 27/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Wet to Dry st: NotStopd t0: [08:00:00 27/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [08:00:00 27/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [08:00:00 27/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 27/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 27/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 27/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 27/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 27/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 27/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 27/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [08:00:00 27/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 27/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 27/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 27/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 27/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: None st: NotStopd
t0: [11:00:00 27/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [11:00:00 27/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [11:00:00 27/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:00:00 27/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [11:00:00 27/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [11:00:00 27/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [11:00:00 27/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:00:00 27/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 27/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:00:00 27/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [11:00:00 27/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [11:00:00 27/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [11:00:00 27/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 27/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 27/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [11:00:00 27/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [11:00:00 27/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [11:00:00 27/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [11:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [11:00:00 27/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 307 u1: ml/B st: NotStopd t0: [11:00:00 27/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [11:00:00 27/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [11:00:00 27/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [11:00:00 27/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [11:00:00 27/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [11:00:00 27/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [11:28:00 27/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.52 rs: Final st: NotStopd t0: [11:28:00 27/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 13 rs: Final st: NotStopd t0: [11:28:00 27/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 39 rs: Final st: NotStopd t0: [11:28:00 27/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 46 u1: mmHg rs: Final st: NotStopd t0: [11:28:00 27/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 118 u1: mmHg rs: Final st: NotStopd t0: [11:28:00 27/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.52 rs: Final st: NotStopd
t0: [11:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [11:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [11:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [11:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [11:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 50 vu: ml
t0: [12:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [12:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [12:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [12:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [12:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 27/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 27/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 27/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 27/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 27/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [10:00:00 27/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 27/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [10:00:00 27/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [12:00:00 27/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 27/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 27/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 27/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 27/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 27/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 27/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [12:00:00 27/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 27/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 27/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 27/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [12:00:00 27/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 27/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [12:00:00 27/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 27/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 27/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [12:00:00 27/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [12:00:00 27/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 27/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 27/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 27/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 27/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [12:00:00 27/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [12:00:00 27/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 27/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [12:00:00 27/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 27/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 27/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 27/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 27/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 27/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 27/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 27/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 27/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [12:00:00 27/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [12:00:00 27/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 27/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [12:00:00 27/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 27/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 27/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 27/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 27/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 27/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [12:00:00 27/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [12:00:00 27/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 27/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 27/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 27/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 27/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [12:00:00 27/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 27/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [12:00:00 27/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 27/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 27/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 27/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 27/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [12:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [12:00:00 27/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 134 rs: Manual st: NotStopd
t0: [12:30:00 27/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:30:00 27/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:30:00 27/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [12:30:00 27/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [12:30:00 27/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [12:30:00 27/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [12:30:00 27/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:30:00 27/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:30:00 27/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [12:00:00 27/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 27/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd
t0: [23:00:00 27/01/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [12:00:00 27/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 27/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5556 u1: Deg. C st: NotStopd t0: [12:00:00 27/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.6 u1: Deg. F st: NotStopd t0: [13:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [13:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [13:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102.667 u1: mmHg st: NotStopd t0: [13:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [13:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [14:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [14:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [14:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.6667 u1: mmHg st: NotStopd t0: [14:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [14:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [15:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [15:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.3333 u1: mmHg st: NotStopd t0: [15:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [15:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [15:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [14:00:00 27/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 27/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 27/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 27/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 27/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 27/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 27/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [14:00:00 27/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 27/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [14:00:00 27/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd
t0: [08:00:00 27/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 27/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 27/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [08:00:00 27/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [12:00:00 27/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 27/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 27/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 27/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 27/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 27/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 27/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 27/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 27/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 27/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [16:00:00 27/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [16:00:00 27/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [16:00:00 27/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 27/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 27/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 27/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 27/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 27/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [16:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 27/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 27/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [16:00:00 27/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [16:00:00 27/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 27/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 27/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 27/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [16:00:00 27/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [16:00:00 27/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 27/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [16:00:00 27/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 27/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 27/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Lethargic st: NotStopd t0: [16:00:00 27/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [16:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104.667 u1: mmHg st: NotStopd t0: [16:00:00 27/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 27/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 27/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 27/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 27/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 27/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 27/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 27/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [16:00:00 27/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 27/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 27/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 27/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [16:00:00 27/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 27/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [16:00:00 27/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 27/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 27/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 27/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 27/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 27/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [16:00:00 27/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 27/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 27/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 27/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 27/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [16:00:00 27/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [16:00:00 27/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [16:00:00 27/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 27/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 27/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:15:00 27/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:15:00 27/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.5926 u1: ml/cmH st: NotStopd t0: [16:15:00 27/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:15:00 27/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:15:00 27/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [16:15:00 27/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [16:15:00 27/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:15:00 27/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:15:00 27/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:15:00 27/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:15:00 27/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:15:00 27/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:15:00 27/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:15:00 27/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [16:15:00 27/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 5.9 u1: L/min st: NotStopd t0: [16:15:00 27/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:15:00 27/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:15:00 27/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [16:15:00 27/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [16:15:00 27/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [16:15:00 27/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [16:15:00 27/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:15:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [16:15:00 27/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: None st: NotStopd t0: [16:15:00 27/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 327 u1: ml/B st: NotStopd t0: [16:15:00 27/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [16:15:00 27/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:15:00 27/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:15:00 27/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:15:00 27/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:15:00 27/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:15:00 27/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:15:00 27/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
tf: [10:00:00 13/02/2016] pt: Unit Dose rt: PO fr: Q8H:PRN m1: Diazepam v1: 2 u1: mg
t0: [17:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [17:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [17:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [17:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [17:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [17:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [18:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 27/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [18:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [18:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [18:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [18:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [20:00:00 27/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 27/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 17 u1: ml/cmH st: NotStopd t0: [20:00:00 27/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 27/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 27/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 27/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 27/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 27/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 27/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 27/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 27/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 27/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 27/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 27/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [20:00:00 27/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 6.7 u1: L/min st: NotStopd t0: [20:00:00 27/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 27/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 27/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [20:00:00 27/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [20:00:00 27/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [20:00:00 27/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [20:00:00 27/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [20:00:00 27/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 27/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 27/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 357 u1: ml/B st: NotStopd t0: [20:00:00 27/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [20:00:00 27/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 27/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 27/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 27/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 27/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 27/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 27/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [19:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [19:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [19:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [19:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [19:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [19:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [20:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [20:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [20:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [20:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 27/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [21:00:00 27/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [21:00:00 27/01/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 27/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [21:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 27/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 27/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [21:00:00 27/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [21:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 27/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [21:00:00 27/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [21:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 27/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [21:00:00 27/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 27/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [21:00:00 27/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 27/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [21:00:00 27/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [21:00:00 27/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [21:00:00 27/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [21:00:00 27/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 27/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [21:00:00 27/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [21:00:00 27/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [21:00:00 27/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [21:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [21:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 27/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [21:00:00 27/01/2016] id: INV Line#2 D/C Date el: 0 cu: MICU cg: RN st: NotStopd t0: [21:00:00 27/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [21:00:00 27/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [21:00:00 27/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 27/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [21:00:00 27/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 27/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 27/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [21:00:00 27/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [21:00:00 27/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [21:00:00 27/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [21:00:00 27/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 27/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 27/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [21:00:00 27/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [21:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [21:00:00 27/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 27/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [21:00:00 27/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 27/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 27/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [21:00:00 27/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 27/01/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 27/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [21:00:00 27/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 27/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [21:00:00 27/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [21:00:00 27/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [21:00:00 27/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 27/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 27/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [21:00:00 27/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 27/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [21:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [21:00:00 27/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [21:00:00 27/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [21:00:00 27/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [21:00:00 27/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [21:00:00 27/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 27/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [21:00:00 27/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [21:00:00 27/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [21:00:00 27/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [21:00:00 27/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [21:00:00 27/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [21:00:00 27/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 27/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [21:00:00 27/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [21:00:00 27/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [21:00:00 27/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 27/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [21:00:00 27/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 27/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 27/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 27/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [22:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [22:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [22:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.6667 u1: mmHg st: NotStopd t0: [22:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [22:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml t0: [21:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [22:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 27/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 350 ap: none
t0: [22:00:00 27/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [22:00:00 27/01/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 27/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [22:00:00 27/01/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 27/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 27/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 27/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [22:00:00 27/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 27/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 27/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [23:00:00 27/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 27/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 27/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 27/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 27/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 27/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [23:00:00 27/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 27/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [23:00:00 27/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [23:00:00 27/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 27/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [23:00:00 27/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 27/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 27/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [00:00:00 28/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 28/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 13.0769 u1: ml/cmH st: NotStopd t0: [00:00:00 28/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 28/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 28/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 28/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 28/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 28/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 28/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 28/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 28/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 28/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 28/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 28/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [00:00:00 28/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.3 u1: L/min st: NotStopd t0: [00:00:00 28/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [00:00:00 28/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 28/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [00:00:00 28/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [00:00:00 28/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [00:00:00 28/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [00:00:00 28/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 28/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 28/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [00:00:00 28/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 357 u1: ml/B st: NotStopd t0: [00:00:00 28/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [00:00:00 28/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 28/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 28/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 28/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 28/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 28/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 28/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 28/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 28/01/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 28/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [00:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [00:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.3333 u1: mmHg st: NotStopd t0: [00:00:00 28/01/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 28/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 28/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [00:00:00 28/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Both Arms st: NotStopd t0: [00:00:00 28/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 28/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 28/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 28/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [01:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 28/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 28/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [01:00:00 28/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [01:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 28/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [01:00:00 28/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [01:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 28/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [01:00:00 28/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [01:00:00 28/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [01:00:00 28/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [01:00:00 28/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [01:00:00 28/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [01:00:00 28/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [01:00:00 28/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [01:00:00 28/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [01:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [01:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 28/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [01:00:00 28/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [01:00:00 28/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [01:00:00 28/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [01:00:00 28/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [01:00:00 28/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 28/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [01:00:00 28/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 28/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 28/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [01:00:00 28/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [01:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 98 u2: mmHg st: NotStopd t0: [01:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 111.667 u1: mmHg st: NotStopd t0: [01:00:00 28/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [01:00:00 28/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 28/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [01:00:00 28/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [01:00:00 28/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [01:00:00 28/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [01:00:00 28/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [01:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 28/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [01:00:00 28/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [01:00:00 28/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [01:00:00 28/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 28/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 28/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [01:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [01:00:00 28/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [01:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 28/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [01:00:00 28/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [01:00:00 28/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [01:00:00 28/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [01:00:00 28/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [01:00:00 28/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [01:00:00 28/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [01:00:00 28/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [01:00:00 28/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [01:00:00 28/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [01:00:00 28/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 28/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [01:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 28/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 144 rs: Manual st: NotStopd t0: [01:00:00 28/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [02:00:00 28/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [02:00:00 28/01/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 28/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [02:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [02:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [02:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97.6667 u1: mmHg st: NotStopd t0: [02:00:00 28/01/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 28/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [02:00:00 28/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [02:00:00 28/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [02:00:00 28/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [02:00:00 28/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [02:00:00 28/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [01:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [02:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 28/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 180 cv: 180 ap: none t0: [23:00:00 28/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -180 cv: -180 ap: none t0: [23:00:00 28/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN cv: 1775 ap: none t0: [23:00:00 28/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 1575 ap: none t0: [23:00:00 28/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 180 cv: 2942 ap: none t0: [23:00:00 28/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -180 cv: -1367 ap: none t0: [23:00:00 28/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 180 cv: 3142 ap: none t0: [23:00:00 28/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -180 cv: 7362.54 ap: carryForward
t0: [03:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [03:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [03:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [03:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [03:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 28/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 28/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 14.7826 u1: ml/cmH st: NotStopd t0: [04:00:00 28/01/2016] id: RSBI (<100) el: 0 cu: MICU cg: RRT u1: units st: NotStopd t0: [04:00:00 28/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 28/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 28/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 28/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 28/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 28/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 28/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 28/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 28/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 28/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 28/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 28/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [04:00:00 28/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.5 u1: L/min st: NotStopd t0: [04:00:00 28/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 28/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 28/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [04:00:00 28/01/2016] id: RSBI (<200) el: 0 cu: MICU cg: RRT u1: units st: NotStopd t0: [04:00:00 28/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [04:00:00 28/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [04:00:00 28/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [04:00:00 28/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [04:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 28/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 28/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [04:00:00 28/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [04:00:00 28/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [04:00:00 28/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 28/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 28/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 28/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 28/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:00:00 28/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 28/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [04:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [04:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.3333 u1: mmHg st: NotStopd t0: [04:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [04:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [05:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [05:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.3333 u1: mmHg st: NotStopd t0: [05:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [05:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [04:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [05:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [04:00:00 28/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [04:00:00 28/01/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [04:00:00 28/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [04:00:00 28/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 28/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 28/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 28/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [04:00:00 28/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [04:00:00 28/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [04:00:00 28/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 28/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 28/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [04:00:00 28/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Back, Lower st: NotStopd t0: [04:00:00 28/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 28/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [04:00:00 28/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [04:00:00 28/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 28/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 28/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 28/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 28/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [04:00:00 28/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 28/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 28/01/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [04:00:00 28/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 28/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 28/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [04:00:00 28/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 28/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [04:00:00 28/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 28/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 28/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 28/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 28/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 28/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 28/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: Done t0: [04:00:00 28/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 28/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 28/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [04:00:00 28/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 28/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 28/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [04:00:00 28/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [05:00:00 28/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [05:00:00 28/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 28/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [05:00:00 28/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [05:00:00 28/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [05:00:00 28/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [05:00:00 28/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [05:00:00 28/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [05:00:00 28/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [05:00:00 28/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97 u1: Deg. F st: NotStopd t0: [06:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 28/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [06:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 28/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [06:00:00 28/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [06:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 28/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [06:00:00 28/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [06:00:00 28/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [06:00:00 28/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [06:00:00 28/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [06:00:00 28/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [06:00:00 28/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [06:00:00 28/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [06:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [06:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 28/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [06:00:00 28/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [06:00:00 28/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 28/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 28/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [06:00:00 28/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [06:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [06:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.6667 u1: mmHg st: NotStopd t0: [06:00:00 28/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [06:00:00 28/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [06:00:00 28/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [06:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 28/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [06:00:00 28/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [06:00:00 28/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [06:00:00 28/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 28/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [06:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [06:00:00 28/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [06:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 28/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [06:00:00 28/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [06:00:00 28/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [06:00:00 28/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [06:00:00 28/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [06:00:00 28/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [06:00:00 28/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [06:00:00 28/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [06:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 28/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 122 rs: Manual st: NotStopd t0: [06:00:00 28/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [07:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [07:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [07:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [07:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [07:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [07:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [07:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [08:00:00 28/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [08:00:00 28/01/2016] id: Pain Level el: 0 cu: MICU cg: RN v1: 0-None st: NotStopd t0: [08:00:00 28/01/2016] id: Pain Level/Response el: 0 cu: MICU cg: RN v1: 0-None st: NotStopd t0: [08:00:00 28/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 28/01/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 28/01/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 28/01/2016] id: PainLevel Acceptable el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [08:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 28/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [08:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 28/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 28/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 28/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi v2: H2 Blocker st: NotStopd t0: [08:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 28/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 28/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 28/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: RN v1: General v2: Anasarca st: NotStopd t0: [08:00:00 28/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 28/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [08:00:00 28/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 28/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [08:00:00 28/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 28/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 28/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 28/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [08:00:00 28/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [08:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 28/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 28/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [08:00:00 28/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [08:00:00 28/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 28/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 28/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 28/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 28/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [08:00:00 28/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 28/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: RN v1: Approximated v2: Clean and Dry st: NotStopd t0: [08:00:00 28/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [08:00:00 28/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 28/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 28/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 28/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 28/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Mediastinal st: NotStopd t0: [08:00:00 28/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 28/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 28/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 28/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [08:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [08:00:00 28/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [08:00:00 28/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 28/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 28/01/2016] id: Pain Level (Rest) el: 0 cu: MICU cg: RN v1: 0-None st: NotStopd t0: [08:00:00 28/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 28/01/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 28/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 28/01/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 28/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 28/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 28/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [08:00:00 28/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 28/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [08:00:00 28/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 28/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 28/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [08:00:00 28/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 28/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [08:00:00 28/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [08:00:00 28/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [08:00:00 28/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [08:00:00 28/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [08:00:00 28/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 28/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [08:00:00 28/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 28/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 28/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 28/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5556 u1: Deg. C st: NotStopd t0: [08:00:00 28/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.6 u1: Deg. F st: NotStopd t0: [08:00:00 28/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 28/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 28/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 28/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 28/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 28/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [08:00:00 28/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 28/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 28/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 28/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd
t0: [08:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [08:30:00 28/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: SRT v1: 1 v2: 23 st: NotStopd t0: [08:30:00 28/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: SRT v1: 16.1905 u1: ml/cmH st: NotStopd t0: [08:30:00 28/01/2016] id: FiO2 Set el: 0 cu: MICU cg: SRT v1: 0.3 u1: torr st: NotStopd t0: [08:30:00 28/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: SRT v1: 45 u1: cmH2O st: NotStopd t0: [08:30:00 28/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: SRT v1: 30 u1: BPM st: NotStopd t0: [08:30:00 28/01/2016] id: Airway Type el: 0 cu: MICU cg: SRT v1: Tracheostomy st: NotStopd t0: [08:30:00 28/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: SRT v1: 34.9 u1: Deg. C st: NotStopd t0: [08:30:00 28/01/2016] id: Intubation Date el: 0 cu: MICU cg: SRT v1: 12 v2: 23 st: NotStopd t0: [08:30:00 28/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: SRT v1: Rhonchi st: NotStopd t0: [08:30:00 28/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: SRT v1: Rhonchi st: NotStopd t0: [08:30:00 28/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: SRT v1: 7.5 st: NotStopd t0: [08:30:00 28/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: SRT v1: 6 v2: Albuterol st: NotStopd t0: [08:30:00 28/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: SRT v1: 6 v2: Atrovent st: NotStopd t0: [08:30:00 28/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: SRT v1: 11 u1: cmH2O st: NotStopd t0: [08:30:00 28/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: SRT v1: 11.9 u1: L/min st: NotStopd t0: [08:30:00 28/01/2016] id: PEEP Set el: 0 cu: MICU cg: SRT v1: 5 u1: cmH2O st: NotStopd t0: [08:30:00 28/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: SRT v1: 20 st: NotStopd t0: [08:30:00 28/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: SRT v1: 26 u1: cmH2O st: NotStopd t0: [08:30:00 28/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: SRT v1: Diminished st: NotStopd t0: [08:30:00 28/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: SRT v1: Coarse st: NotStopd t0: [08:30:00 28/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: SRT v1: 24 u1: BPM st: NotStopd t0: [08:30:00 28/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: SRT v1: 34 u1: BPM st: NotStopd t0: [08:30:00 28/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: SRT v1: Regular st: NotStopd t0: [08:30:00 28/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: SRT v1: 10 u1: BPM st: NotStopd t0: [08:30:00 28/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: SRT v1: 13 u1: cmH2O st: NotStopd t0: [08:30:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRT v1: 99 u1: % st: NotStopd t0: [08:30:00 28/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: SRT v1: Brown v2: Thick st: NotStopd t0: [08:30:00 28/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: SRT v1: Suctioned v2: Scant st: NotStopd t0: [08:30:00 28/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: SRT v1: 348 u1: ml/B st: NotStopd t0: [08:30:00 28/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: SRT v1: 340 u1: ml/B st: NotStopd t0: [08:30:00 28/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: SRT v1: Yes v2: No st: NotStopd t0: [08:30:00 28/01/2016] id: Trach Size el: 0 cu: MICU cg: SRT v1: #8 st: NotStopd t0: [08:30:00 28/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: SRT v1: Portex st: NotStopd t0: [08:30:00 28/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: SRT v1: Assist Control st: NotStopd t0: [08:30:00 28/01/2016] id: Ventilator Type el: 0 cu: MICU cg: SRT v1: Drager st: NotStopd t0: [08:30:00 28/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: SRT v1: RAMP st: NotStopd
t0: [08:40:00 28/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: SRT v1: 5 st: NotStopd
t0: [09:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [09:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [09:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [09:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [09:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:30:00 28/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: SRT v1: 1 v2: 23 st: NotStopd t0: [09:30:00 28/01/2016] id: FiO2 Set el: 0 cu: MICU cg: SRT v1: 0.3 u1: torr st: NotStopd t0: [09:30:00 28/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: SRT v1: 45 u1: cmH2O st: NotStopd t0: [09:30:00 28/01/2016] id: Airway Size el: 0 cu: MICU cg: SRT v1: 8.0 mm st: NotStopd t0: [09:30:00 28/01/2016] id: Airway Type el: 0 cu: MICU cg: SRT v1: Tracheostomy st: NotStopd t0: [09:30:00 28/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: SRT v1: 35.1 u1: Deg. C st: NotStopd t0: [09:30:00 28/01/2016] id: Intubation Date el: 0 cu: MICU cg: SRT v1: 12 v2: 23 st: NotStopd t0: [09:30:00 28/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: SRT v1: 5 st: NotStopd t0: [09:30:00 28/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: SRT v1: 9 u1: cmH2O st: NotStopd t0: [09:30:00 28/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: SRT v1: 12.8 u1: L/min st: NotStopd t0: [09:30:00 28/01/2016] id: PEEP Set el: 0 cu: MICU cg: SRT v1: 5 u1: cmH2O st: NotStopd t0: [09:30:00 28/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: SRT v1: 20 st: NotStopd t0: [09:30:00 28/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: SRT v1: 27 u1: cmH2O st: NotStopd t0: [09:30:00 28/01/2016] id: Pressure Support el: 0 cu: MICU cg: SRT v1: 20 u1: . st: NotStopd t0: [09:30:00 28/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: SRT v1: 38 u1: BPM st: NotStopd t0: [09:30:00 28/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: SRT v1: 5 u1: cmH2O st: NotStopd t0: [09:30:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRT v1: 100 u1: % st: NotStopd t0: [09:30:00 28/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: SRT v1: White v2: Thick st: NotStopd t0: [09:30:00 28/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: SRT v1: Suctioned v2: Small st: NotStopd t0: [09:30:00 28/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: SRT v1: 300 u1: ml/B st: NotStopd t0: [09:30:00 28/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: SRT v1: Yes v2: No st: NotStopd t0: [09:30:00 28/01/2016] id: Trach Size el: 0 cu: MICU cg: SRT v1: #8 st: NotStopd t0: [09:30:00 28/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: SRT v1: Portex st: NotStopd t0: [09:30:00 28/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: SRT v1: CPAP+PS st: NotStopd t0: [09:30:00 28/01/2016] id: Ventilator Type el: 0 cu: MICU cg: SRT v1: Drager st: NotStopd t0: [09:30:00 28/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: SRT v1: RAMP st: NotStopd
t0: [09:30:00 28/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: SRT v1: 55 u1: BPM st: NotStopd
tf: [11:00:00 15/02/2016] pt: Unit Dose rt: NG fr: QD fs: 10 dn: 1 m1: Lansoprazole Oral Suspension v1: 30 u1: mg
t0: [10:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [10:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [10:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [10:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [10:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [10:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 86 u1: BPM st: NotStopd t0: [10:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [10:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 143 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [10:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 94.3333 u1: mmHg st: NotStopd t0: [10:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [10:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 29 u1: BPM st: NotStopd t0: [10:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRN v1: 100 u1: % st: NotStopd t0: [10:00:00 28/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: SRN v1: 37.8333 u1: Deg. C st: NotStopd t0: [10:00:00 28/01/2016] id: Temperature F el: 0 cu: MICU cg: SRN v1: 100.1 u1: Deg. F st: NotStopd t0: [10:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 28/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: SRN v1: Blister st: NotStopd t0: [08:00:00 28/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [08:00:00 28/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: SRN st: NotStopd t0: [08:00:00 28/01/2016] id: Skin Integrity el: 0 cu: MICU cg: SRN v1: Impaired st: NotStopd t0: [08:00:00 28/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: SRN v1: Warm v2: Dry st: NotStopd
t0: [08:00:00 28/01/2016] id: Braden Score el: 0 cu: MICU cg: SRN v1: 14 u1: number st: NotStopd t0: [08:00:00 28/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: SRN v1: Sl. Limited st: NotStopd
t0: [10:00:00 28/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: SRN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [11:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [11:00:00 28/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: SRN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [11:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [11:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [11:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 85 u1: BPM st: NotStopd t0: [11:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [11:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 142 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [11:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 93.3333 u1: mmHg st: NotStopd t0: [11:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [11:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 32 u1: BPM st: NotStopd t0: [11:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRN v1: 100 u1: % st: NotStopd t0: [11:00:00 28/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: SRN v1: 37.6111 u1: Deg. C st: NotStopd t0: [11:00:00 28/01/2016] id: Temperature F el: 0 cu: MICU cg: SRN v1: 99.7 u1: Deg. F st: NotStopd t0: [11:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: SRN ai: 498 vo: 75 vu: ml t0: [10:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: SRN ai: 498 vo: 75 vu: ml t0: [11:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: SRN ai: 498 vo: 75 vu: ml
t0: [08:00:00 28/01/2016] id: Eye Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [08:00:00 28/01/2016] id: Oral Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [08:00:00 28/01/2016] id: Skin Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd
t0: [11:26:00 28/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: SRT v1: 1 v2: 23 st: NotStopd t0: [11:26:00 28/01/2016] id: Cuff Leak el: 0 cu: MICU cg: SRT v1: No st: NotStopd t0: [11:26:00 28/01/2016] id: FiO2 Set el: 0 cu: MICU cg: SRT v1: 0.3 u1: torr st: NotStopd t0: [11:26:00 28/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: SRT v1: 45 u1: cmH2O st: NotStopd t0: [11:26:00 28/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: SRT v1: 55 u1: BPM st: NotStopd t0: [11:26:00 28/01/2016] id: Airway Size el: 0 cu: MICU cg: SRT v1: 8.0 mm st: NotStopd t0: [11:26:00 28/01/2016] id: Airway Type el: 0 cu: MICU cg: SRT v1: Tracheostomy st: NotStopd t0: [11:26:00 28/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: SRT v1: 35 u1: Deg. C st: NotStopd t0: [11:26:00 28/01/2016] id: Intubation Date el: 0 cu: MICU cg: SRT v1: 12 v2: 23 st: NotStopd t0: [11:26:00 28/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: SRT v1: 5 st: NotStopd t0: [11:26:00 28/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: SRT v1: 6 v2: Albuterol st: NotStopd t0: [11:26:00 28/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: SRT v1: 6 v2: Atrovent st: NotStopd t0: [11:26:00 28/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: SRT v1: 9 u1: cmH2O st: NotStopd t0: [11:26:00 28/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: SRT v1: 13.4 u1: L/min st: NotStopd t0: [11:26:00 28/01/2016] id: PEEP Set el: 0 cu: MICU cg: SRT v1: 5 u1: cmH2O st: NotStopd t0: [11:26:00 28/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: SRT v1: 20 st: NotStopd t0: [11:26:00 28/01/2016] id: Pressure Support el: 0 cu: MICU cg: SRT v1: 20 u1: . st: NotStopd t0: [11:26:00 28/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: SRT v1: 46 u1: BPM st: NotStopd t0: [11:26:00 28/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: SRT v1: 5 u1: cmH2O st: NotStopd t0: [11:26:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRT v1: 100 u1: % st: NotStopd t0: [11:26:00 28/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: SRT v1: Yellow v2: Thin st: NotStopd t0: [11:26:00 28/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: SRT v1: Suctioned v2: Small st: NotStopd t0: [11:26:00 28/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: SRT v1: 300 u1: ml/B st: NotStopd t0: [11:26:00 28/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: SRT v1: Yes v2: No st: NotStopd t0: [11:26:00 28/01/2016] id: Trach Size el: 0 cu: MICU cg: SRT v1: #8 st: NotStopd t0: [11:26:00 28/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: SRT v1: Inflated st: NotStopd t0: [11:26:00 28/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: SRT v1: Portex st: NotStopd t0: [11:26:00 28/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: SRT v1: CPAP+PS st: NotStopd t0: [11:26:00 28/01/2016] id: Ventilator Type el: 0 cu: MICU cg: SRT v1: Drager st: NotStopd t0: [11:26:00 28/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: SRT v1: RAMP st: NotStopd
t0: [12:00:00 28/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 139 rs: Manual st: NotStopd
t0: [12:00:00 28/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: SRN v1: Orientation st: NotStopd t0: [12:00:00 28/01/2016] id: Pain Level el: 0 cu: MICU cg: SRN v1: 0-None st: NotStopd t0: [12:00:00 28/01/2016] id: Pain Level/Response el: 0 cu: MICU cg: SRN v1: 0-None st: NotStopd t0: [12:00:00 28/01/2016] id: Pain Present el: 0 cu: MICU cg: SRN v1: No st: NotStopd t0: [12:00:00 28/01/2016] id: Range of Motion el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [12:00:00 28/01/2016] id: Pain Assess Method el: 0 cu: MICU cg: SRN v1: Non-verbal cues st: NotStopd t0: [12:00:00 28/01/2016] id: PainLevel Acceptable el: 0 cu: MICU cg: SRN v1: Not Applicable st: NotStopd t0: [12:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [12:00:00 28/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: SRN v1: Circulation Adeq st: NotStopd t0: [12:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [12:00:00 28/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: SRN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 28/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: SRN v1: No/Not Sedated st: NotStopd t0: [12:00:00 28/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: SRN v1: Proton/Pump/Inhi v2: H2 Blocker st: NotStopd t0: [12:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [12:00:00 28/01/2016] id: Diet Type el: 0 cu: MICU cg: SRN v1: Tube Feeding st: NotStopd t0: [12:00:00 28/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: SRN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 28/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: SRN v1: General v2: Anasarca st: NotStopd t0: [12:00:00 28/01/2016] id: Eye Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [12:00:00 28/01/2016] id: Eye Opening el: 0 cu: MICU cg: SRN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 28/01/2016] id: Follows Commands el: 0 cu: MICU cg: SRN v1: Consistently st: NotStopd t0: [12:00:00 28/01/2016] id: GCS Total el: 0 cu: MICU cg: SRN v1: 11 u1: points st: NotStopd t0: [12:00:00 28/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: SRN v1: Salem Sump v2: Oral st: NotStopd t0: [12:00:00 28/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [12:00:00 28/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: SRN v1: Feeding st: NotStopd t0: [12:00:00 28/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: SRN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 28/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: SRN v1: 16 French st: NotStopd t0: [12:00:00 28/01/2016] id: HOB el: 0 cu: MICU cg: SRN v1: 45 degrees st: NotStopd t0: [12:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 84 u1: BPM st: NotStopd t0: [12:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [12:00:00 28/01/2016] id: Height of Bed el: 0 cu: MICU cg: SRN v1: 45 degrees st: NotStopd t0: [12:00:00 28/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: SRN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [12:00:00 28/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: SRN v1: 1 v2: 26 st: NotStopd t0: [12:00:00 28/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: SRN v1: Other/Remarks st: NotStopd t0: [12:00:00 28/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: SRN v1: Soft Distended st: NotStopd t0: [12:00:00 28/01/2016] id: Activity el: 0 cu: MICU cg: SRN v1: Bedrest st: NotStopd t0: [12:00:00 28/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: SRN v1: Tolerated Well st: NotStopd t0: [12:00:00 28/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: SRN v1: Blister st: NotStopd t0: [12:00:00 28/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 28/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: SRN v1: Open to Air st: NotStopd t0: [12:00:00 28/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: SRN v1: Chest st: NotStopd t0: [12:00:00 28/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: SRN v1: Approximated v2: Clean and Dry st: NotStopd t0: [12:00:00 28/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: SRN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [12:00:00 28/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 28/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 28/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 28/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 28/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: SRN v1: Sternum st: NotStopd t0: [12:00:00 28/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: SRN v1: Mediastinal st: NotStopd t0: [12:00:00 28/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [12:00:00 28/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [12:00:00 28/01/2016] id: Level of Conscious el: 0 cu: MICU cg: SRN v1: Alert st: NotStopd t0: [12:00:00 28/01/2016] id: Motor Response el: 0 cu: MICU cg: SRN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 139 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [12:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 94.3333 u1: mmHg st: NotStopd t0: [12:00:00 28/01/2016] id: Oral Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [12:00:00 28/01/2016] id: Oral Cavity el: 0 cu: MICU cg: SRN v1: Oral Ulcers st: NotStopd t0: [12:00:00 28/01/2016] id: Orientation el: 0 cu: MICU cg: SRN v1: Other/Remarks st: NotStopd t0: [12:00:00 28/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: SRN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 28/01/2016] id: Pain Level (Rest) el: 0 cu: MICU cg: SRN v1: 0-None st: NotStopd t0: [12:00:00 28/01/2016] id: Pain Location el: 0 cu: MICU cg: SRN v1: Not Indicated st: NotStopd t0: [12:00:00 28/01/2016] id: Pain Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 28/01/2016] id: Position el: 0 cu: MICU cg: SRN v1: Right Side st: NotStopd t0: [12:00:00 28/01/2016] id: Position Change el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [12:00:00 28/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: SRN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 28/01/2016] id: Assistance Device el: 0 cu: MICU cg: SRN v1: 2 Person Assist st: NotStopd t0: [12:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [12:00:00 28/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: SRN v1: Multipodus Boots st: NotStopd t0: [12:00:00 28/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: SRN v1: Brisk v2: Brisk st: NotStopd t0: [12:00:00 28/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: SRN v1: 4 mm v2: 4 mm st: NotStopd t0: [12:00:00 28/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: SRN v1: Diminished st: NotStopd t0: [12:00:00 28/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [12:00:00 28/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: SRN v1: Ext/TXInterfere st: NotStopd t0: [12:00:00 28/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [12:00:00 28/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: SRN v1: Tachypneic st: NotStopd t0: [12:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 36 u1: BPM st: NotStopd t0: [12:00:00 28/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: SRN v1: Verbal v2: Withdraws st: NotStopd t0: [12:00:00 28/01/2016] id: Restraint Location el: 0 cu: MICU cg: SRN v1: Right Arm st: NotStopd t0: [12:00:00 28/01/2016] id: Restraint Type el: 0 cu: MICU cg: SRN v1: Soft Limb st: NotStopd t0: [12:00:00 28/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: SRN v1: Behavior Conts st: NotStopd t0: [12:00:00 28/01/2016] id: Side Rails el: 0 cu: MICU cg: SRN v1: Side Rails Up st: NotStopd t0: [12:00:00 28/01/2016] id: Skin Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [12:00:00 28/01/2016] id: Skin Integrity el: 0 cu: MICU cg: SRN v1: Impaired st: NotStopd t0: [12:00:00 28/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: SRN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRN v1: 99 u1: % st: NotStopd t0: [12:00:00 28/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: SRN v1: Purposeful st: NotStopd t0: [12:00:00 28/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: SRN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 28/01/2016] id: Stool Management el: 0 cu: MICU cg: SRN v1: Mushroom Cath st: NotStopd t0: [12:00:00 28/01/2016] id: Support Systems el: 0 cu: MICU cg: SRN v1: Spouse st: NotStopd t0: [12:00:00 28/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: SRN v1: 37.5556 u1: Deg. C st: NotStopd t0: [12:00:00 28/01/2016] id: Temperature F el: 0 cu: MICU cg: SRN v1: 99.6 u1: Deg. F st: NotStopd t0: [12:00:00 28/01/2016] id: Turn el: 0 cu: MICU cg: SRN v1: Right Side st: NotStopd t0: [12:00:00 28/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: SRN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 28/01/2016] id: Urine Source el: 0 cu: MICU cg: SRN v1: Indwelling Cath st: NotStopd t0: [12:00:00 28/01/2016] id: Verbal Response el: 0 cu: MICU cg: SRN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd t0: [12:00:00 28/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: SRN v1: Present st: NotStopd t0: [12:00:00 28/01/2016] id: Braden Activity el: 0 cu: MICU cg: SRN v1: Chairfast st: NotStopd t0: [12:00:00 28/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: SRN v1: Potential Prob st: NotStopd t0: [12:00:00 28/01/2016] id: Braden Mobility el: 0 cu: MICU cg: SRN v1: Very Limited st: NotStopd t0: [12:00:00 28/01/2016] id: Braden Moisture el: 0 cu: MICU cg: SRN v1: Occ. Moist st: NotStopd t0: [12:00:00 28/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: SRN v1: Prob. Inadequate st: NotStopd t0: [12:00:00 28/01/2016] id: Braden Score el: 0 cu: MICU cg: SRN v1: 13 u1: number st: NotStopd t0: [12:00:00 28/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: SRN v1: Very Limited st: NotStopd
t0: [12:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: SRN ai: 498 vo: 75 vu: ml
t0: [12:46:00 28/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.54 rs: Final st: NotStopd t0: [12:46:00 28/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 15 rs: Final st: NotStopd t0: [12:46:00 28/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 41 rs: Final st: NotStopd t0: [12:46:00 28/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 47 u1: mmHg rs: Final st: NotStopd t0: [12:46:00 28/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 128 u1: mmHg rs: Final st: NotStopd t0: [12:46:00 28/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.54 rs: Final st: NotStopd
t0: [12:46:00 28/01/2016] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [12:46:00 28/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 rs: Final st: NotStopd t0: [12:46:00 28/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd t0: [12:46:00 28/01/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [12:46:00 28/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 rs: Final st: NotStopd t0: [12:46:00 28/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 142 rs: Final st: NotStopd
t0: [13:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [13:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [13:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.3333 u1: mmHg st: NotStopd t0: [13:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [13:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
tf: [13:00:00 29/01/2016] pt: IV Piggyback rt: IV fr: ONCE MR1 fs: 13 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml
t0: [14:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [14:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [14:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [14:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [14:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [14:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 84 u1: BPM st: NotStopd t0: [14:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [14:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 140 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [14:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 91.3333 u1: mmHg st: NotStopd t0: [14:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [14:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 31 u1: BPM st: NotStopd t0: [14:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRN v1: 99 u1: % st: NotStopd t0: [14:00:00 28/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: SRN v1: 37.3889 u1: Deg. C st: NotStopd t0: [14:00:00 28/01/2016] id: Temperature F el: 0 cu: MICU cg: SRN v1: 99.3 u1: Deg. F st: NotStopd t0: [14:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: SRN ai: 498 vo: 75 vu: ml t0: [14:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: SRN ai: 498 vo: 75 vu: ml
t0: [15:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [15:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [15:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [15:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [15:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [15:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 82 u1: BPM st: NotStopd t0: [15:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [15:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 144 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [15:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 95.3333 u1: mmHg st: NotStopd t0: [15:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [15:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 35 u1: BPM st: NotStopd t0: [15:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRN v1: 100 u1: % st: NotStopd t0: [15:00:00 28/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: SRN v1: 37.3889 u1: Deg. C st: NotStopd t0: [15:00:00 28/01/2016] id: Temperature F el: 0 cu: MICU cg: SRN v1: 99.3 u1: Deg. F st: NotStopd t0: [15:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: SRN ai: 498 vo: 75 vu: ml
t0: [16:00:00 28/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: SRN v1: Family at Bedsid st: NotStopd t0: [16:00:00 28/01/2016] id: Pain Level el: 0 cu: MICU cg: SRN v1: 0-None st: NotStopd t0: [16:00:00 28/01/2016] id: Pain Level/Response el: 0 cu: MICU cg: SRN v1: 0-None st: NotStopd t0: [16:00:00 28/01/2016] id: Pain Present el: 0 cu: MICU cg: SRN v1: No st: NotStopd t0: [16:00:00 28/01/2016] id: Range of Motion el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 28/01/2016] id: Pain Assess Method el: 0 cu: MICU cg: SRN v1: Non-verbal cues st: NotStopd t0: [16:00:00 28/01/2016] id: PainLevel Acceptable el: 0 cu: MICU cg: SRN v1: Not Applicable st: NotStopd t0: [16:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [16:00:00 28/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: SRN v1: Circulation Adeq st: NotStopd t0: [16:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [16:00:00 28/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: SRN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 28/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: SRN v1: No/Not Sedated st: NotStopd t0: [16:00:00 28/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: SRN v1: Proton/Pump/Inhi v2: H2 Blocker st: NotStopd t0: [16:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [16:00:00 28/01/2016] id: Diet Type el: 0 cu: MICU cg: SRN v1: Tube Feeding st: NotStopd t0: [16:00:00 28/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: SRN v1: Strong/Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 28/01/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: SRN v1: General v2: Anasarca st: NotStopd t0: [16:00:00 28/01/2016] id: Eye Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 28/01/2016] id: Eye Opening el: 0 cu: MICU cg: SRN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 28/01/2016] id: Family Communication el: 0 cu: MICU cg: SRN v1: Family Visited st: NotStopd t0: [16:00:00 28/01/2016] id: Follows Commands el: 0 cu: MICU cg: SRN v1: Consistently st: NotStopd t0: [16:00:00 28/01/2016] id: GCS Total el: 0 cu: MICU cg: SRN v1: 11 u1: points st: NotStopd t0: [16:00:00 28/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: SRN v1: Salem Sump v2: Oral st: NotStopd t0: [16:00:00 28/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 28/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: SRN v1: Feeding st: NotStopd t0: [16:00:00 28/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: SRN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 28/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: SRN v1: 16 French st: NotStopd t0: [16:00:00 28/01/2016] id: HOB el: 0 cu: MICU cg: SRN v1: Other/Remarks st: NotStopd t0: [16:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 86 u1: BPM st: NotStopd t0: [16:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [16:00:00 28/01/2016] id: Height of Bed el: 0 cu: MICU cg: SRN v1: Other/Remarks st: NotStopd t0: [16:00:00 28/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: SRN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [16:00:00 28/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: SRN v1: 1 v2: 26 st: NotStopd t0: [16:00:00 28/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: SRN v1: Other/Remarks st: NotStopd t0: [16:00:00 28/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: SRN v1: Soft Distended st: NotStopd t0: [16:00:00 28/01/2016] id: Activity el: 0 cu: MICU cg: SRN v1: Chair st: NotStopd t0: [16:00:00 28/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: SRN v1: Fair st: NotStopd t0: [16:00:00 28/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: SRN v1: Blister st: NotStopd t0: [16:00:00 28/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 28/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: SRN v1: Open to Air st: NotStopd t0: [16:00:00 28/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: SRN v1: Chest st: NotStopd t0: [16:00:00 28/01/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: SRN v1: Approximated v2: Clean and Dry st: NotStopd t0: [16:00:00 28/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: SRN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 28/01/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 28/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 28/01/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 28/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 28/01/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: SRN v1: Sternum st: NotStopd t0: [16:00:00 28/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: SRN v1: Mediastinal st: NotStopd t0: [16:00:00 28/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [16:00:00 28/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [16:00:00 28/01/2016] id: Level of Conscious el: 0 cu: MICU cg: SRN v1: Alert st: NotStopd t0: [16:00:00 28/01/2016] id: Motor Response el: 0 cu: MICU cg: SRN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 138 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [16:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 94 u1: mmHg st: NotStopd t0: [16:00:00 28/01/2016] id: Oral Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 28/01/2016] id: Oral Cavity el: 0 cu: MICU cg: SRN v1: Oral Ulcers st: NotStopd t0: [16:00:00 28/01/2016] id: Orientation el: 0 cu: MICU cg: SRN v1: Other/Remarks st: NotStopd t0: [16:00:00 28/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: SRN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 28/01/2016] id: Pain Level (Rest) el: 0 cu: MICU cg: SRN v1: 0-None st: NotStopd t0: [16:00:00 28/01/2016] id: Pain Location el: 0 cu: MICU cg: SRN v1: Not Indicated st: NotStopd t0: [16:00:00 28/01/2016] id: Pain Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 28/01/2016] id: Position el: 0 cu: MICU cg: SRN v1: Supine st: NotStopd t0: [16:00:00 28/01/2016] id: Position Change el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 28/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: SRN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 28/01/2016] id: Assistance Device el: 0 cu: MICU cg: SRN v1: 2 Person Assist st: NotStopd t0: [16:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [16:00:00 28/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: SRN v1: Brisk v2: Brisk st: NotStopd t0: [16:00:00 28/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: SRN v1: 3 mm v2: 3 mm st: NotStopd t0: [16:00:00 28/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: SRN v1: Diminished st: NotStopd t0: [16:00:00 28/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [16:00:00 28/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: SRN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 28/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 28/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: SRN v1: Tachypneic st: NotStopd t0: [16:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 33 u1: BPM st: NotStopd t0: [16:00:00 28/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: SRN v1: Verbal v2: Withdraws st: NotStopd t0: [16:00:00 28/01/2016] id: Restraint Location el: 0 cu: MICU cg: SRN v1: Right Arm st: NotStopd t0: [16:00:00 28/01/2016] id: Restraint Type el: 0 cu: MICU cg: SRN v1: Soft Limb st: NotStopd t0: [16:00:00 28/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: SRN v1: Behavior Conts st: NotStopd t0: [16:00:00 28/01/2016] id: Side Rails el: 0 cu: MICU cg: SRN v1: Side Rails Up st: NotStopd t0: [16:00:00 28/01/2016] id: Skin Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 28/01/2016] id: Skin Integrity el: 0 cu: MICU cg: SRN v1: Impaired st: NotStopd t0: [16:00:00 28/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: SRN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRN v1: 97 u1: % st: NotStopd t0: [16:00:00 28/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: SRN v1: Purposeful st: NotStopd t0: [16:00:00 28/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: SRN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 28/01/2016] id: Stool Management el: 0 cu: MICU cg: SRN v1: Mushroom Cath st: NotStopd t0: [16:00:00 28/01/2016] id: Support Systems el: 0 cu: MICU cg: SRN v1: Relative st: NotStopd t0: [16:00:00 28/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: SRN v1: 37.3889 u1: Deg. C st: NotStopd t0: [16:00:00 28/01/2016] id: Temperature F el: 0 cu: MICU cg: SRN v1: 99.3 u1: Deg. F st: NotStopd t0: [16:00:00 28/01/2016] id: Turn el: 0 cu: MICU cg: SRN st: NotStopd t0: [16:00:00 28/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: SRN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 28/01/2016] id: Urine Source el: 0 cu: MICU cg: SRN v1: Indwelling Cath st: NotStopd t0: [16:00:00 28/01/2016] id: Verbal Response el: 0 cu: MICU cg: SRN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd t0: [16:00:00 28/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: SRN v1: Present st: NotStopd t0: [16:00:00 28/01/2016] id: Braden Activity el: 0 cu: MICU cg: SRN v1: Chairfast st: NotStopd t0: [16:00:00 28/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: SRN v1: Potential Prob st: NotStopd t0: [16:00:00 28/01/2016] id: Braden Mobility el: 0 cu: MICU cg: SRN v1: Very Limited st: NotStopd t0: [16:00:00 28/01/2016] id: Braden Moisture el: 0 cu: MICU cg: SRN v1: Occ. Moist st: NotStopd t0: [16:00:00 28/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: SRN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 28/01/2016] id: Braden Score el: 0 cu: MICU cg: SRN v1: 13 u1: number st: NotStopd t0: [16:00:00 28/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: SRN v1: Very Limited st: NotStopd
t0: [16:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: SRN ai: 498 vo: 75 vu: ml
t0: [23:00:00 28/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: SRN cv: 200 ap: none
t0: [16:39:00 28/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:39:00 28/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 26.1905 u1: ml/cmH st: NotStopd t0: [16:39:00 28/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:39:00 28/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:39:00 28/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [16:39:00 28/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [16:39:00 28/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:39:00 28/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:39:00 28/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:39:00 28/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:39:00 28/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:39:00 28/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:39:00 28/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:39:00 28/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [16:39:00 28/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.4 u1: L/min st: NotStopd t0: [16:39:00 28/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [16:39:00 28/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:39:00 28/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [16:39:00 28/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [16:39:00 28/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [16:39:00 28/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [16:39:00 28/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:39:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [16:39:00 28/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 400 u1: ml/B st: NotStopd t0: [16:39:00 28/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 550 u1: ml/B st: NotStopd t0: [16:39:00 28/01/2016] id: Total PEEP Level el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:39:00 28/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:39:00 28/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:39:00 28/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:39:00 28/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:39:00 28/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:39:00 28/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:39:00 28/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
tf: [16:00:00 29/01/2016] pt: Unit Dose rt: IV fr: ONCE MR1 fs: 17 dn: 1 m1: Alteplase (Catheter Clearance) v1: 1 u1: mg
t0: [17:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [17:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [17:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [17:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [17:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [17:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 85 u1: BPM st: NotStopd t0: [17:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [17:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 140 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [17:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 94 u1: mmHg st: NotStopd t0: [17:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [17:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 31 u1: BPM st: NotStopd t0: [17:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRN v1: 100 u1: % st: NotStopd t0: [17:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: SRN ai: 498 vo: 75 vu: ml
t0: [18:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [18:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [18:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [18:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [18:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [18:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 87 u1: BPM st: NotStopd t0: [18:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [18:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 140 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [18:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 95.3333 u1: mmHg st: NotStopd t0: [18:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [18:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: SRN v1: 91 u1: % st: NotStopd t0: [18:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 28/01/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: SRN cv: 200 ap: none
t0: [20:00:00 28/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 28/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 28/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 28/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 28/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 28/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 28/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 28/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 28/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 28/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 28/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 28/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 28/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [20:00:00 28/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.2 u1: L/min st: NotStopd t0: [20:00:00 28/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 28/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [20:00:00 28/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [20:00:00 28/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [20:00:00 28/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 28/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 28/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 28/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 344 u1: ml/B st: NotStopd t0: [20:00:00 28/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [20:00:00 28/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 28/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 28/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 28/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 28/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 28/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 28/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [18:00:00 28/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Family at Bedsid st: NotStopd t0: [18:00:00 28/01/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 28/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [18:00:00 28/01/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 28/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [18:00:00 28/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 28/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [18:00:00 28/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [18:00:00 28/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [18:00:00 28/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [19:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [19:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [19:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.6667 u1: mmHg st: NotStopd t0: [19:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [19:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 28/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Family at Bedsid st: NotStopd t0: [20:00:00 28/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 28/01/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 28/01/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 28/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 28/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [20:00:00 28/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: H2 Blocker st: NotStopd t0: [20:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 28/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 28/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 28/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 28/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 28/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 28/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [20:00:00 28/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 28/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [20:00:00 28/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [20:00:00 28/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 28/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 28/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [20:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 28/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 28/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [20:00:00 28/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [20:00:00 28/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 28/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 28/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 28/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 28/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 28/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 28/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 28/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [20:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.6667 u1: mmHg st: NotStopd t0: [20:00:00 28/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [20:00:00 28/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 28/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 28/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 28/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [20:00:00 28/01/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 28/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 28/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 28/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 28/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [20:00:00 28/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 28/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 28/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 28/01/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 28/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 39 u1: BPM st: NotStopd t0: [20:00:00 28/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Withdraws st: NotStopd t0: [20:00:00 28/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: Right Arm st: NotStopd t0: [20:00:00 28/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 28/01/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [20:00:00 28/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 28/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [20:00:00 28/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 28/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 28/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [20:00:00 28/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [20:00:00 28/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [20:00:00 28/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [20:00:00 28/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [20:00:00 28/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 28/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 28/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 28/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [21:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [21:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [21:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [21:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [21:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 90 u1: % st: NotStopd t0: [21:00:00 28/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [21:00:00 28/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [21:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 28/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 225 vu: ml st: Stopped
t0: [23:31:00 28/01/2016] id: Venous CO2(Calc) VBG'S el: 0 cu: MICU cg: 1663 v1: 36 rs: Final st: NotStopd t0: [23:31:00 28/01/2016] id: Venous PvCO2 VBG's el: 0 cu: MICU cg: 1663 v1: 30 u1: mmHg rs: Final st: NotStopd t0: [23:31:00 28/01/2016] id: Venous PvO2 Mixed Venous Gases el: 0 cu: MICU cg: 1663 v1: 47 u1: mmHg rs: Final st: NotStopd t0: [23:31:00 28/01/2016] id: Venous pH VBG's el: 0 cu: MICU cg: 1663 v1: 7.67 u1: pH rs: Final st: NotStopd
t0: [23:32:00 28/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.66 rs: Final st: NotStopd t0: [23:32:00 28/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 15 rs: Final st: NotStopd t0: [23:32:00 28/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 38 rs: Final st: NotStopd t0: [23:32:00 28/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 33 u1: mmHg rs: Final st: NotStopd t0: [23:32:00 28/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 82 u1: mmHg rs: Final st: NotStopd t0: [23:32:00 28/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.66 rs: Final st: NotStopd
t0: [23:00:00 28/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 15.2 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 37.8 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 15.2 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 37.8 rs: Final st: NotStopd
t0: [23:00:00 28/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 18.7 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 18.7 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 25.8 u1: % rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8.5 u1: gm/dl rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 458 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.84 u1: /mic l rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 18.7 rs: Final st: NotStopd
t0: [20:00:00 28/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [23:00:00 28/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 68 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 9.3 u1: mg/dl rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 u1: mEq/L rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 144 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 68 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 9.3 u1: mg/dl rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 36 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.5 u1: mEq/L rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 rs: Final st: NotStopd t0: [23:00:00 28/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 144 rs: Final st: NotStopd t0: [00:00:00 29/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 29/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 29/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 29/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 29/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [00:00:00 29/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 29/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 29/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 29/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 29/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 29/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 29/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 29/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [00:00:00 29/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.33 u1: L/min st: NotStopd t0: [00:00:00 29/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 29/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [00:00:00 29/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [00:00:00 29/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [00:00:00 29/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 29/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 96 u1: % st: NotStopd t0: [00:00:00 29/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [00:00:00 29/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [00:00:00 29/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 29/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 29/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 29/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 29/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 29/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 29/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [22:00:00 28/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [22:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [22:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [22:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [22:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 28/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [22:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 44 u1: BPM st: NotStopd t0: [22:00:00 28/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 28/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [22:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [22:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 28/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 28/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 28/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 28/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 28/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 28/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [23:00:00 28/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [23:00:00 28/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [23:00:00 28/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 28/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 28/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [23:00:00 28/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [23:00:00 28/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.6667 u1: mmHg st: NotStopd t0: [23:00:00 28/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [23:00:00 28/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [23:00:00 28/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [23:00:00 28/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [23:00:00 28/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 28/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [23:00:00 28/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 41 u1: BPM st: NotStopd t0: [23:00:00 28/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [23:00:00 28/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 28/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [23:00:00 28/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [23:00:00 28/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 28/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 158 rs: Manual st: NotStopd t0: [00:00:00 29/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [00:00:00 29/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 29/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 29/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 29/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: H2 Blocker st: NotStopd t0: [00:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 29/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 29/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [00:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 29/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 29/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [00:00:00 29/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 29/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [00:00:00 29/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [00:00:00 29/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped v2: Undigested Food st: NotStopd t0: [00:00:00 29/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 29/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [00:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 29/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 29/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [00:00:00 29/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [00:00:00 29/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 29/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 29/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 29/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 29/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 29/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [00:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.3333 u1: mmHg st: NotStopd t0: [00:00:00 29/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [00:00:00 29/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 29/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 29/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 29/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 29/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [00:00:00 29/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 29/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 29/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 29/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [00:00:00 29/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 29/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 29/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [00:00:00 29/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 29/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 29/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 29/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5 u1: Deg. C st: NotStopd t0: [00:00:00 29/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.7 u1: Deg. F st: NotStopd t0: [00:00:00 29/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 29/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 29/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 29/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [01:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [01:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [01:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [01:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [01:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 29/01/2016] tf: [12:00:00 29/01/2016] dt: 720 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml st: Restart t0: [01:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 29/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -160 cv: -160 ap: none t0: [23:00:00 29/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN cv: 2715 ap: none t0: [23:00:00 29/01/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 230 ap: none t0: [23:00:00 29/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 1575 ap: none t0: [23:00:00 29/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -160 cv: 115 ap: carryForward t0: [23:00:00 29/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -160 cv: 7477.54 ap: carryForward
tf: [01:00:00 30/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 2 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [01:00:00 30/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 2 dn: 1 m1: Potassium Phosphate v1: 30 u1: mmol m2: NS v2: 250 u2: ml
t0: [02:20:00 29/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.46 rs: Final st: NotStopd t0: [02:20:00 29/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 13 rs: Final st: NotStopd t0: [02:20:00 29/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 40 rs: Final st: NotStopd t0: [02:20:00 29/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 55 u1: mmHg rs: Final st: NotStopd t0: [02:20:00 29/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 110 u1: mmHg rs: Final st: NotStopd t0: [02:20:00 29/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.46 rs: Final st: NotStopd
t0: [20:00:00 28/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.1429 u1: ml/cmH st: NotStopd t0: [20:00:00 28/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 29/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 14.7059 u1: ml/cmH st: NotStopd t0: [00:00:00 29/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 29/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 29/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 20.8333 u1: ml/cmH st: NotStopd t0: [04:00:00 29/01/2016] id: RSBI (<100) el: 0 cu: MICU cg: RRT u1: units st: NotStopd t0: [04:00:00 29/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 29/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 29/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 29/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [04:00:00 29/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 29/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 29/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 29/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 29/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 29/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 29/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 29/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 7 u1: cmH2O st: NotStopd t0: [04:00:00 29/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.7 u1: L/min st: NotStopd t0: [04:00:00 29/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 29/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 29/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [04:00:00 29/01/2016] id: RSBI (<200) el: 0 cu: MICU cg: RRT u1: units st: NotStopd t0: [04:00:00 29/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [04:00:00 29/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [04:00:00 29/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 29/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [04:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 29/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [04:00:00 29/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [04:00:00 29/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [04:00:00 29/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [04:00:00 29/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 29/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 29/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 29/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 29/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:00:00 29/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 29/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [02:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [02:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [02:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [02:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [02:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 29/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [03:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [03:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 29/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 29/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [03:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.6667 u1: mmHg st: NotStopd t0: [03:00:00 29/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 29/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [03:00:00 29/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [03:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 29/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [03:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [03:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 29/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [03:00:00 29/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [03:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [04:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [04:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [04:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [04:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 29/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [05:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 29/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 29/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [05:00:00 29/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: H2 Blocker st: NotStopd t0: [05:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 29/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [05:00:00 29/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [05:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 29/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [05:00:00 29/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [05:00:00 29/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [05:00:00 29/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [05:00:00 29/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [05:00:00 29/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [05:00:00 29/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [05:00:00 29/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [05:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [05:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 29/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 29/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [05:00:00 29/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [05:00:00 29/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 29/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [05:00:00 29/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 29/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 29/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [05:00:00 29/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [05:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [05:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [05:00:00 29/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [05:00:00 29/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 29/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [05:00:00 29/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [05:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 29/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [05:00:00 29/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [05:00:00 29/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [05:00:00 29/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 29/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [05:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [05:00:00 29/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [05:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 29/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [05:00:00 29/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [05:00:00 29/01/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [05:00:00 29/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [05:00:00 29/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [05:00:00 29/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 35.3333 u1: Deg. C st: NotStopd t0: [05:00:00 29/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 95.6 u1: Deg. F st: NotStopd t0: [05:00:00 29/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [05:00:00 29/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 29/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [05:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 29/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [06:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 29/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 29/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [06:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [06:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 29/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 29/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [06:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105.667 u1: mmHg st: NotStopd t0: [06:00:00 29/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 29/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 29/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 29/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [06:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 29/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [06:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [06:00:00 29/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 29/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [06:00:00 29/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 29/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 29/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: DONE t0: [06:00:00 29/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 141 rs: Manual st: NotStopd
t0: [02:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [03:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [04:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [05:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [06:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [07:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [05:00:00 29/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 16.3 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 16.3 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 26.3 u1: % rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8 u1: gm/dl rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 406 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.81 u1: /mic l rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 16.3 rs: Final st: NotStopd
t0: [05:00:00 29/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 14.7 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 31.8 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14.7 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 31.8 rs: Final st: NotStopd
t0: [05:00:00 29/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 65 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 9.2 u1: mg/dl rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 147 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 65 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 9.2 u1: mg/dl rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 37 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [05:00:00 29/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 147 rs: Final st: NotStopd
t0: [08:00:00 29/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 17.8571 u1: ml/cmH st: NotStopd t0: [08:00:00 29/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 29/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 29/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [08:00:00 29/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 29/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 29/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [08:00:00 29/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 29/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 29/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 29/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 29/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [08:00:00 29/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.7 u1: L/min st: NotStopd t0: [08:00:00 29/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 29/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 29/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [08:00:00 29/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [08:00:00 29/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [08:00:00 29/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 29/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 29/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 278 u1: ml/B st: NotStopd t0: [08:00:00 29/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [08:00:00 29/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 29/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 29/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [07:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [07:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [07:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.3333 u1: mmHg st: NotStopd t0: [07:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [07:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [08:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [08:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [08:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [08:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 29/01/2016] id: Less Restrict Meas. el: 0 cu: MICU cg: RN v1: Orientation st: NotStopd t0: [09:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 29/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: H2 Blocker st: NotStopd t0: [09:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 29/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [09:00:00 29/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [09:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 29/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [09:00:00 29/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 29/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [09:00:00 29/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [09:00:00 29/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [09:00:00 29/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Salem Sump v2: Oral st: NotStopd t0: [09:00:00 29/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 29/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [09:00:00 29/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [09:00:00 29/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [09:00:00 29/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [09:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 29/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 29/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [09:00:00 29/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [09:00:00 29/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [09:00:00 29/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [09:00:00 29/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 29/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 29/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [09:00:00 29/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [09:00:00 29/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serous v2: Scant st: NotStopd t0: [09:00:00 29/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 29/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [09:00:00 29/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [09:00:00 29/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [09:00:00 29/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [09:00:00 29/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [09:00:00 29/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [09:00:00 29/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 29/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [09:00:00 29/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 29/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 29/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [09:00:00 29/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [09:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [09:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [09:00:00 29/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Oral Ulcers st: NotStopd t0: [09:00:00 29/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [09:00:00 29/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 29/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 29/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [09:00:00 29/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [09:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 29/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [09:00:00 29/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [09:00:00 29/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [09:00:00 29/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [09:00:00 29/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 29/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [09:00:00 29/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [09:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [09:00:00 29/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [09:00:00 29/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 29/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [09:00:00 29/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [09:00:00 29/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [09:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 29/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [09:00:00 29/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [09:00:00 29/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [09:00:00 29/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 29/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [09:00:00 29/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [09:00:00 29/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [09:00:00 29/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [09:00:00 29/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [09:00:00 29/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [09:00:00 29/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [09:00:00 29/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [09:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 29/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [09:00:00 29/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [09:00:00 29/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [09:00:00 29/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [09:00:00 29/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [09:00:00 29/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [09:00:00 29/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [09:00:00 29/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [09:00:00 29/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [09:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [10:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [10:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [10:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [10:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [10:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:30:00 29/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [10:30:00 29/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [10:30:00 29/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:30:00 29/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [10:30:00 29/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [11:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [11:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [11:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 107.333 u1: mmHg st: NotStopd t0: [11:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [11:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [14:00:00 29/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [14:00:00 29/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 19.2308 u1: ml/cmH st: NotStopd t0: [14:00:00 29/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [14:00:00 29/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [14:00:00 29/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [14:00:00 29/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [14:00:00 29/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [14:00:00 29/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [14:00:00 29/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [14:00:00 29/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [14:00:00 29/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [14:00:00 29/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [14:00:00 29/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [14:00:00 29/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [14:00:00 29/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [14:00:00 29/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [14:00:00 29/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [14:00:00 29/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [14:00:00 29/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 23 u1: BPM st: NotStopd t0: [14:00:00 29/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 43 u1: BPM st: NotStopd t0: [14:00:00 29/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [14:00:00 29/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [14:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [14:00:00 29/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [14:00:00 29/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [14:00:00 29/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 275 u1: ml/B st: NotStopd t0: [14:00:00 29/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [14:00:00 29/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [14:00:00 29/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [14:00:00 29/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [14:00:00 29/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [14:00:00 29/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [14:00:00 29/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [14:00:00 29/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [12:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [12:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [12:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 29/01/2016] id: Procedures el: 0 cu: MICU cg: RN v1: Fluoroscopy st: NotStopd t0: [14:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 29/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [14:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 29/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [14:00:00 29/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [14:00:00 29/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 29/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [14:00:00 29/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [14:00:00 29/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 29/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 29/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [14:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [14:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [14:00:00 29/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 29/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [14:00:00 29/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 29/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [14:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [14:00:00 29/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 29/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [14:00:00 29/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 29/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml st: Stopped
t0: [23:00:00 29/01/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 300 ap: carryForward
t0: [16:10:00 29/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:10:00 29/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:10:00 29/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:10:00 29/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:10:00 29/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [16:10:00 29/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:10:00 29/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:10:00 29/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.8 u1: Deg. C st: NotStopd t0: [16:10:00 29/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:10:00 29/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:10:00 29/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [16:10:00 29/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.5 u1: L/min st: NotStopd t0: [16:10:00 29/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:10:00 29/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:10:00 29/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [16:10:00 29/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 15 u1: . st: NotStopd t0: [16:10:00 29/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [16:10:00 29/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:10:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [16:10:00 29/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [16:10:00 29/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [16:10:00 29/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 316 u1: ml/B st: NotStopd t0: [16:10:00 29/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:10:00 29/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:10:00 29/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:10:00 29/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:10:00 29/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:10:00 29/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [17:00:00 29/01/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: -1 st: D/C'd
t0: [15:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 29/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 29/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 29/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 29/01/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 29/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 29/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [16:00:00 29/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 29/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 29/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 29/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 29/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [16:00:00 29/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [16:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 29/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 29/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 29/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 29/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 29/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 29/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [16:00:00 29/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serosanguinous v2: Scant st: NotStopd t0: [16:00:00 29/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 29/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 29/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [16:00:00 29/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [16:00:00 29/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 29/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [16:00:00 29/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [16:00:00 29/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 29/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 29/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 29/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 29/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 29/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [16:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [16:00:00 29/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 29/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 29/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 29/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 29/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 29/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 29/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 29/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [16:00:00 29/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [16:00:00 29/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [16:00:00 29/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 29/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 29/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [16:00:00 29/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [16:00:00 29/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 29/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 29/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [16:00:00 29/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 29/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 29/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [16:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 29/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [16:00:00 29/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 29/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 29/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 29/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [16:00:00 29/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.4 u1: Deg. F st: NotStopd t0: [16:00:00 29/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 29/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [16:00:00 29/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 29/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 29/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 29/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 29/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 29/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 29/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 29/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [16:00:00 29/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 29/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [16:00:00 29/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 29/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [16:00:00 29/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [17:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [17:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 29/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [17:00:00 29/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [17:00:00 29/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [17:00:00 29/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [17:00:00 29/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [17:00:00 29/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [17:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [17:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103.333 u1: mmHg st: NotStopd t0: [17:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [17:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 29/01/2016] tf: [10:00:00 01/02/2016] dt: 3900 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml t0: [17:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 225 vu: ml
t0: [18:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [18:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [18:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.3333 u1: mmHg st: NotStopd t0: [18:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [18:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:39:00 29/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 59 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 106 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 94 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 150 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 59 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 35 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 106 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 94 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 u1: mEq/L rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [17:39:00 29/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 150 rs: Final st: NotStopd
t0: [19:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [19:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [19:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.6667 u1: mmHg st: NotStopd t0: [19:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 42 u1: BPM st: NotStopd t0: [19:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 29/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [20:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [20:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [20:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [20:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd t0: [20:00:00 29/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [20:00:00 29/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [20:00:00 29/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 29/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [20:00:00 29/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [20:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 225 vu: ml
tf: [19:00:00 30/01/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 20 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: D5W v2: 500 u2: ml tf: [19:00:00 30/01/2016] pt: Unit Dose rt: IV fr: ONCE fs: 20 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [20:00:00 29/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 29/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 29/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 29/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 29/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 29/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 29/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 29/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 29/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 29/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 29/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 29/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 29/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:00:00 29/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.3 u1: L/min st: NotStopd t0: [20:00:00 29/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 29/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 29/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 15 u1: . st: NotStopd t0: [20:00:00 29/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [20:00:00 29/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [20:00:00 29/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 263 u1: ml/B st: NotStopd t0: [20:00:00 29/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 29/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 29/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 29/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 29/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 29/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:44:00 29/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd
t0: [21:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [21:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [21:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.333 u1: mmHg st: NotStopd t0: [21:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [21:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [22:14:00 29/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.46 rs: Final st: NotStopd t0: [22:14:00 29/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 11 rs: Final st: NotStopd t0: [22:14:00 29/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 39 rs: Final st: NotStopd t0: [22:14:00 29/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 53 u1: mmHg rs: Final st: NotStopd t0: [22:14:00 29/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 78 u1: mmHg rs: Final st: NotStopd t0: [22:14:00 29/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.46 rs: Final st: NotStopd
t0: [20:00:00 29/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 29/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 29/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [20:00:00 29/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 29/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [20:00:00 29/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 29/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 29/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 29/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 29/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 29/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [20:00:00 29/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [20:00:00 29/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 29/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 29/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 29/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 29/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [20:00:00 29/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 29/01/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: RN v1: Blister st: NotStopd t0: [20:00:00 29/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serosanguinous v2: Small st: NotStopd t0: [20:00:00 29/01/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 29/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 29/01/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: RN v1: Open to Air st: NotStopd t0: [20:00:00 29/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [20:00:00 29/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 29/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [20:00:00 29/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Suture/Staples v2: Clean and Dry st: NotStopd t0: [20:00:00 29/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 29/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 29/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 29/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 29/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 29/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 29/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 29/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 29/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 29/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 29/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [20:00:00 29/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [20:00:00 29/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 29/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [20:00:00 29/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 29/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 29/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [20:00:00 29/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 29/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Cool v2: Dry st: NotStopd t0: [20:00:00 29/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [20:00:00 29/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [20:00:00 29/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 29/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 29/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 29/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [20:00:00 29/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 29/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 29/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 29/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 29/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [22:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 29/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [22:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [22:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [22:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [22:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 29/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 29/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 910 ap: none
t0: [22:00:00 29/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [22:00:00 29/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [22:00:00 29/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [22:00:00 29/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [22:00:00 29/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [22:00:00 29/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [22:00:00 29/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [23:00:00 29/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd
id: Free Water Bolus el: 1 cu: MICU cg: RN io: Free Water Bolus PO/Gastric du: ml rt: Nasogastric
t0: [23:00:00 29/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 29/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 29/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 29/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 29/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 29/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [23:00:00 29/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 29/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 160 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [23:00:00 29/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 108 u1: mmHg st: NotStopd t0: [23:00:00 29/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 29/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [23:00:00 29/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 29/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 29/01/2016] tf: [22:00:00 07/02/2016] dt: 12960 id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 200 vu: ml
t0: [23:00:00 29/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 160 cv: 160 ap: none t0: [23:00:00 29/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 160 cv: 2300 ap: none t0: [23:00:00 29/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 160 cv: 2600 ap: carryForward
t0: [00:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [00:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [00:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [00:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [00:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [00:00:00 30/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 30/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [00:00:00 30/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [00:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 30/01/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 560 ap: none
t0: [00:00:00 30/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 146 rs: Manual st: NotStopd
t0: [22:00:00 29/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [22:00:00 29/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [01:00:00 30/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [01:00:00 30/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [01:00:00 30/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [01:00:00 30/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [01:00:00 30/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [01:00:00 30/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [01:00:00 30/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [01:00:00 30/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:00:00 30/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 30/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [01:00:00 30/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [01:00:00 30/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [01:00:00 30/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [01:00:00 30/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [01:00:00 30/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 30/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 30/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [01:00:00 30/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [01:00:00 30/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [01:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [01:00:00 30/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [01:00:00 30/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [01:00:00 30/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [01:00:00 30/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [01:00:00 30/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [01:00:00 30/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [01:00:00 30/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [01:00:00 30/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [01:00:00 30/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 30/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [01:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [01:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.6667 u1: mmHg st: NotStopd t0: [01:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [01:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [02:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [02:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [02:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.6667 u1: mmHg st: NotStopd t0: [02:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [02:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [02:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 30/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 30/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 30/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN cv: 2460 ap: none t0: [23:00:00 30/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 1650 ap: none t0: [23:00:00 30/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 1325 ap: none t0: [23:00:00 30/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN cv: 685 ap: none t0: [23:00:00 30/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 1775 ap: none t0: [23:00:00 30/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN cv: 8162.54 ap: carryForward
t0: [03:00:00 30/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd
t0: [04:00:00 30/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 30/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 30/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:00:00 30/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [04:00:00 30/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 30/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 30/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 30/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 30/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [04:00:00 30/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 30/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 30/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [04:00:00 30/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.8 u1: L/min st: NotStopd t0: [04:00:00 30/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 30/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 30/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [04:00:00 30/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 46 u1: BPM st: NotStopd t0: [04:00:00 30/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [04:00:00 30/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [04:00:00 30/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 30/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 253 u1: ml/B st: NotStopd t0: [04:00:00 30/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 30/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 30/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 30/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:00:00 30/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 29/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 29/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 29/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 29/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [20:00:00 29/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 29/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 30/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 30/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 30/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 30/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [00:00:00 30/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 30/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 30/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [00:00:00 30/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 30/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 16 French st: NotStopd t0: [00:00:00 30/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 30/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 30/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 30/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 30/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 30/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 30/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [00:00:00 30/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 30/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 30/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 30/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 30/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 30/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Thrush st: NotStopd t0: [00:00:00 30/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 30/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 30/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 30/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 30/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [00:00:00 30/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 30/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [00:00:00 30/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 30/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 30/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [00:00:00 30/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 30/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 30/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 30/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [00:00:00 30/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [00:00:00 30/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 30/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 30/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 30/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 30/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 30/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 30/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 30/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 30/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 30/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 30/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 30/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 30/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 30/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 30/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 30/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [00:00:00 30/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [02:00:00 30/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [02:00:00 30/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [02:00:00 30/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [02:00:00 30/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [02:00:00 30/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [02:00:00 30/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [03:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [03:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [03:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [03:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [03:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [03:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 30/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 30/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 30/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 30/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 30/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [04:00:00 30/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 30/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 30/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [04:00:00 30/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 30/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 30/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [04:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 30/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 30/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 30/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 30/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 30/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 30/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 30/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 30/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 30/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 30/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 30/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [04:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [04:00:00 30/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Thrush st: NotStopd t0: [04:00:00 30/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 30/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 30/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 30/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 30/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 30/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 30/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [04:00:00 30/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 30/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 30/01/2016] id: Reason For Restraint el: 0 cu: MICU cg: RN v1: Ext/TXInterfere st: NotStopd t0: [04:00:00 30/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [04:00:00 30/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 30/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 30/01/2016] id: Restraint Type el: 0 cu: MICU cg: RN v1: Soft Limb st: NotStopd t0: [04:00:00 30/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [04:00:00 30/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 30/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 30/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 30/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 30/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 30/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 30/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 30/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 30/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [04:00:00 30/01/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 200 vu: ml t0: [04:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [04:00:00 30/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 30/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.9444 u1: Deg. C st: NotStopd t0: [04:00:00 30/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.5 u1: Deg. F st: NotStopd t0: [05:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [05:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [05:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [05:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [05:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [06:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [06:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [06:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [06:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [07:40:00 30/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [07:40:00 30/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [07:40:00 30/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [07:40:00 30/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [07:40:00 30/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 60 u1: BPM st: NotStopd t0: [07:40:00 30/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [07:40:00 30/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [07:40:00 30/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:40:00 30/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:40:00 30/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [07:40:00 30/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:40:00 30/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:40:00 30/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 9 u1: cmH2O st: NotStopd t0: [07:40:00 30/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.2 u1: L/min st: NotStopd t0: [07:40:00 30/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:40:00 30/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [07:40:00 30/01/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [07:40:00 30/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 43 u1: BPM st: NotStopd t0: [07:40:00 30/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [07:40:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [07:40:00 30/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [07:40:00 30/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [07:40:00 30/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 294 u1: ml/B st: NotStopd t0: [07:40:00 30/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [07:40:00 30/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [07:40:00 30/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [07:40:00 30/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [07:40:00 30/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [07:40:00 30/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [08:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 30/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [09:00:00 30/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [09:00:00 30/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [09:00:00 30/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [09:00:00 30/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 60 u1: BPM st: NotStopd t0: [09:00:00 30/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [09:00:00 30/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [09:00:00 30/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [09:00:00 30/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [09:00:00 30/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [09:00:00 30/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [09:00:00 30/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.38 u1: L/min st: NotStopd t0: [09:00:00 30/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [09:00:00 30/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [09:00:00 30/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [09:00:00 30/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 21 u1: BPM st: NotStopd t0: [09:00:00 30/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 41 u1: BPM st: NotStopd t0: [09:00:00 30/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [09:00:00 30/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [09:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [09:00:00 30/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 309 u1: ml/B st: NotStopd t0: [09:00:00 30/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [09:00:00 30/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [09:00:00 30/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [09:00:00 30/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [09:00:00 30/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [09:00:00 30/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [09:00:00 30/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 30/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 30/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 30/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 30/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 30/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 30/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 30/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 30/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [08:00:00 30/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 30/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 30/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 30/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 30/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 30/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 30/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 30/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 30/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 30/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [08:00:00 30/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [08:00:00 30/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 30/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 30/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [08:00:00 30/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 30/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 30/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 30/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 30/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 30/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 30/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 30/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 30/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 30/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 30/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 30/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [08:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 109 u1: mmHg st: NotStopd t0: [08:00:00 30/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 30/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Thrush st: NotStopd t0: [08:00:00 30/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 30/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 30/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 30/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [08:00:00 30/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [08:00:00 30/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 30/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 30/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 43 u1: BPM st: NotStopd t0: [08:00:00 30/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 30/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 30/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 30/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 30/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 30/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [08:00:00 30/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 30/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 30/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 30/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 30/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [08:00:00 30/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [08:00:00 30/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 30/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 30/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 30/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 30/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 30/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 30/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 30/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 30/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 30/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 30/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [08:00:00 30/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [09:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 92 u2: mmHg st: NotStopd t0: [09:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 110.333 u1: mmHg st: NotStopd t0: [09:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [09:00:00 30/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [09:00:00 30/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd
t0: [08:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [09:30:00 30/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.8 u1: L/min st: NotStopd t0: [09:30:00 30/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd
t0: [09:00:00 30/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 16.1 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 16.1 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 25.5 u1: % rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 7.8 u1: gm/dl rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 447 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.69 u1: /mic l rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 16.1 rs: Final st: NotStopd
t0: [10:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [10:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [10:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [10:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [10:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 30/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 48 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.6 u1: mg/dl rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 83 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 148 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 48 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.6 u1: mg/dl rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 37 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 107 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 83 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 148 rs: Final st: NotStopd
t0: [09:00:00 30/01/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 14.1 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 37.5 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14.1 rs: Final st: NotStopd t0: [09:00:00 30/01/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 37.5 rs: Final st: NotStopd
t0: [11:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [11:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [11:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [11:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [11:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 225 vu: ml
t0: [12:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 30/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 30/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 30/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 30/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 30/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 30/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [12:00:00 30/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 30/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 30/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 30/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 30/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [12:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 30/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 30/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 30/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 30/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [12:00:00 30/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [12:00:00 30/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 30/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 30/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 30/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [12:00:00 30/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 30/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 30/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 30/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 30/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 30/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Thrush st: NotStopd t0: [12:00:00 30/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 30/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [12:00:00 30/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 30/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 30/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [12:00:00 30/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 30/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 30/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 30/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [12:00:00 30/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 30/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 30/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 30/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 30/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [12:00:00 30/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [12:00:00 30/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [12:00:00 30/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 30/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 30/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [09:00:00 30/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.069 u1: ml/cmH st: NotStopd t0: [09:00:00 30/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [11:45:00 30/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [11:45:00 30/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.069 u1: ml/cmH st: NotStopd t0: [11:45:00 30/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [11:45:00 30/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [11:45:00 30/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [11:45:00 30/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 60 u1: BPM st: NotStopd t0: [11:45:00 30/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [11:45:00 30/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:45:00 30/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:45:00 30/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:45:00 30/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [11:45:00 30/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:45:00 30/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:45:00 30/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [11:45:00 30/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.7 u1: L/min st: NotStopd t0: [11:45:00 30/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:45:00 30/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:45:00 30/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [11:45:00 30/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [11:45:00 30/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [11:45:00 30/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [11:45:00 30/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [11:45:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [11:45:00 30/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [11:45:00 30/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [11:45:00 30/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 383 u1: ml/B st: NotStopd t0: [11:45:00 30/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [11:45:00 30/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [11:45:00 30/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [11:45:00 30/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [11:45:00 30/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [11:45:00 30/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [11:45:00 30/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [11:45:00 30/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [12:00:00 30/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 134 rs: Manual st: NotStopd
t0: [12:00:00 30/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 30/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 30/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [12:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd
tf: [12:00:00 31/01/2016] pt: Unit Dose rt: PO fr: ONCE fs: 13 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq tf: [12:00:00 31/01/2016] pt: Unit Dose rt: PO fr: ONCE fs: 13 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq
t0: [13:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [13:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [13:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.3333 u1: mmHg st: NotStopd t0: [13:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [13:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [14:30:00 30/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd
t0: [14:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [14:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [14:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.3333 u1: mmHg st: NotStopd t0: [14:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [14:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 30/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [14:00:00 30/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [14:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [13:00:00 30/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 30/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 30/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [13:00:00 30/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 30/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [13:00:00 30/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:00:00 30/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [13:00:00 30/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 30/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [13:00:00 30/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [13:00:00 30/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [15:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 91 u1: BPM st: NotStopd t0: [15:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [15:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [15:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [15:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [15:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 30/01/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 240 vu: ml t0: [15:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [15:20:00 30/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [15:20:00 30/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 11.6667 u1: ml/cmH st: NotStopd t0: [15:20:00 30/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [15:20:00 30/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [15:20:00 30/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [15:20:00 30/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [15:20:00 30/01/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:4.5 st: NotStopd t0: [15:20:00 30/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [15:20:00 30/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [15:20:00 30/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.8 u1: Deg. C st: NotStopd t0: [15:20:00 30/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [15:20:00 30/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [15:20:00 30/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [15:20:00 30/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [15:20:00 30/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [15:20:00 30/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.8 u1: L/min st: NotStopd t0: [15:20:00 30/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [15:20:00 30/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [15:20:00 30/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [15:20:00 30/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [15:20:00 30/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [15:20:00 30/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [15:20:00 30/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [15:20:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [15:20:00 30/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [15:20:00 30/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [15:20:00 30/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 337 u1: ml/B st: NotStopd t0: [15:20:00 30/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [15:20:00 30/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [15:20:00 30/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [15:20:00 30/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [15:20:00 30/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [15:20:00 30/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [15:20:00 30/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [15:20:00 30/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [16:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [16:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [16:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97.3333 u1: mmHg st: NotStopd t0: [16:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [16:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 30/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 250 ap: none
tf: [18:00:00 30/01/2016] pt: Unit Dose rt: TP fr: QID:PRN m1: Nystatin Ointment v1: 1 u1: Appl
t0: [16:00:00 30/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 30/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 30/01/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 30/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 30/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 30/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 30/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 30/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [16:00:00 30/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 30/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 30/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 30/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 30/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 30/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 30/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 30/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 30/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 30/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 30/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 30/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Thrush st: NotStopd t0: [16:00:00 30/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 30/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 30/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 30/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 30/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 30/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 30/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 30/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [16:00:00 30/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 30/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 30/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:00:00 30/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 30/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 30/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [17:00:00 30/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 23 st: NotStopd t0: [17:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [17:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 30/01/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [17:00:00 30/01/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [17:00:00 30/01/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [17:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [17:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [17:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [17:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 30/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [17:00:00 30/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [17:00:00 30/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [17:00:00 30/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [17:00:00 30/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [17:00:00 30/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [17:00:00 30/01/2016] id: Trach Size el: 0 cu: MICU cg: RN v1: #8 st: NotStopd t0: [17:00:00 30/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Portex st: NotStopd t0: [17:00:00 30/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [17:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [18:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [18:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.6667 u1: mmHg st: NotStopd t0: [18:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [18:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 30/01/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 450 ap: none
t0: [16:00:00 30/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 30/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [16:00:00 30/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 30/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 30/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 30/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [18:00:00 30/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 124 rs: Manual st: NotStopd
t0: [16:00:00 30/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 30/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 30/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip st: NotStopd t0: [16:00:00 30/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 30/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 30/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 30/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [17:00:00 30/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [17:00:00 30/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [17:00:00 30/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [17:00:00 30/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [17:00:00 30/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [17:00:00 30/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [17:00:00 30/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [17:00:00 30/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 30/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [17:00:00 30/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 30/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 30/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [17:00:00 30/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 30/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [17:00:00 30/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 30/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [17:00:00 30/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [17:00:00 30/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [18:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [21:00:00 26/02/2016] pt: Unit Dose rt: PO fr: QID:PRN m1: Nystatin Oral Suspension v1: 5 u1: ml
t0: [20:00:00 30/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 30/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 30/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 30/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 30/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 30/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 30/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 30/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 30/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [20:00:00 30/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 30/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 30/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 30/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 30/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 30/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [20:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 30/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 30/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 30/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 30/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 30/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [20:00:00 30/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [20:00:00 30/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 30/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 30/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 30/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [20:00:00 30/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 30/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 30/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [20:00:00 30/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip st: NotStopd t0: [20:00:00 30/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 30/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 30/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 30/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 30/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 30/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 30/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [20:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.3333 u1: mmHg st: NotStopd t0: [20:00:00 30/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Thrush st: NotStopd t0: [20:00:00 30/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 30/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 30/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 30/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 30/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 30/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 30/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 30/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 30/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [20:00:00 30/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 30/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 30/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 30/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 30/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [20:00:00 30/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [20:00:00 30/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 30/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 30/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 30/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 30/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 30/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 30/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38 u1: Deg. C st: NotStopd t0: [20:00:00 30/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.4 u1: Deg. F st: NotStopd t0: [20:00:00 30/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 30/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 30/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 30/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 30/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 30/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [21:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [21:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [21:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [21:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [21:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 30/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [22:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 30/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [22:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [22:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.6667 u1: mmHg st: NotStopd t0: [22:00:00 30/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [22:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [22:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [22:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 30/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [22:00:00 30/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [22:00:00 30/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10 u1: ml/cmH st: NotStopd t0: [22:00:00 30/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [22:00:00 30/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [22:00:00 30/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [22:00:00 30/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [22:00:00 30/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [22:00:00 30/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [22:00:00 30/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [22:00:00 30/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [22:00:00 30/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [22:00:00 30/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [22:00:00 30/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [22:00:00 30/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [22:00:00 30/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.7 u1: L/min st: NotStopd t0: [22:00:00 30/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [22:00:00 30/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [22:00:00 30/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [22:00:00 30/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 2 u1: BPM st: NotStopd t0: [22:00:00 30/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [22:00:00 30/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [22:00:00 30/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [22:00:00 30/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 380 u1: ml/B st: NotStopd t0: [22:00:00 30/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [22:00:00 30/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [22:00:00 30/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [22:00:00 30/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [22:00:00 30/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [22:00:00 30/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [22:00:00 30/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [22:00:00 30/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [23:00:00 30/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 30/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 30/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 30/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 30/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 30/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [23:00:00 30/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 30/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [23:00:00 30/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.6667 u1: mmHg st: NotStopd t0: [23:00:00 30/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 30/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [23:00:00 30/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 88 u1: % st: NotStopd t0: [23:00:00 30/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 31/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 31/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 31/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 31/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 31/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 31/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 31/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 31/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 31/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [00:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 31/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 31/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 31/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 31/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [00:00:00 31/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [00:00:00 31/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 31/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 31/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 31/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [00:00:00 31/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 31/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [00:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102.667 u1: mmHg st: NotStopd t0: [00:00:00 31/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 31/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [00:00:00 31/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [00:00:00 31/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 31/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 31/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 31/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 31/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 31/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 31/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 31/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 31/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [00:00:00 31/01/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 200 vu: ml t0: [00:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [23:00:00 31/01/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 650 ap: none
t0: [00:00:00 31/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 120 rs: Manual st: NotStopd
t0: [01:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [01:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [01:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.3333 u1: mmHg st: NotStopd t0: [01:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [01:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 31/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [02:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 31/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [02:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 31/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [02:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [02:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [02:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [03:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [03:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [03:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [03:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [03:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 31/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [03:00:00 31/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [03:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [04:00:00 31/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 31/01/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Grimace Scale st: NotStopd t0: [04:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 31/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 31/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 31/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 31/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [04:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 31/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [04:00:00 31/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 31/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 31/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [04:00:00 31/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 31/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 31/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 31/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 31/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 31/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [04:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 31/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 31/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 31/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 31/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 31/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [04:00:00 31/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [04:00:00 31/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 31/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 31/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 31/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 31/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 31/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 31/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 31/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 31/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 31/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Stimul st: NotStopd t0: [04:00:00 31/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [04:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.6667 u1: mmHg st: NotStopd t0: [04:00:00 31/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 31/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 31/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 31/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 31/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [04:00:00 31/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 31/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 31/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 31/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [04:00:00 31/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 31/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 31/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [04:00:00 31/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal st: NotStopd t0: [04:00:00 31/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 31/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 31/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [04:00:00 31/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 31/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 31/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 31/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 31/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 31/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 31/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [04:00:00 31/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [04:00:00 31/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 31/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 31/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 31/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 31/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 31/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [04:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [03:00:00 31/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [03:00:00 31/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 11.2903 u1: ml/cmH st: NotStopd t0: [03:00:00 31/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [03:00:00 31/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [03:00:00 31/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [03:00:00 31/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [03:00:00 31/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [03:00:00 31/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [03:00:00 31/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [03:00:00 31/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [03:00:00 31/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [03:00:00 31/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [03:00:00 31/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [03:00:00 31/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [03:00:00 31/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [03:00:00 31/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [03:00:00 31/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [03:00:00 31/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [03:00:00 31/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [03:00:00 31/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [03:00:00 31/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [03:00:00 31/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [03:00:00 31/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 380 u1: ml/B st: NotStopd t0: [03:00:00 31/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [03:00:00 31/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [03:00:00 31/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [03:00:00 31/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [03:00:00 31/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [03:00:00 31/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [03:00:00 31/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [03:00:00 31/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [03:34:00 31/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 15 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 15 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 24.4 u1: % rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 7.5 u1: gm/dl rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 407 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.57 u1: /mic l rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 15 rs: Final st: NotStopd
t0: [03:34:00 31/01/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 43 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.8 u1: mg/dl rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 117 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 u1: mEq/L rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 148 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 43 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.8 u1: mg/dl rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 35 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.1 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 117 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 u1: mEq/L rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [03:34:00 31/01/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 148 rs: Final st: NotStopd
t0: [02:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [02:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.333 u1: mmHg st: NotStopd t0: [05:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [05:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [05:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.3333 u1: mmHg st: NotStopd t0: [05:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [05:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [05:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 31/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 31/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [06:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [06:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.3333 u1: mmHg st: NotStopd t0: [06:00:00 31/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [06:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [06:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [06:00:00 31/01/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 200 vu: ml t0: [06:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 31/01/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 200 ap: none
t0: [00:00:00 31/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 31/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [00:00:00 31/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [06:00:00 31/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [06:00:00 31/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 31/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [06:00:00 31/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 31/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 31/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 31/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 31/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [06:00:00 31/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [06:00:00 31/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [06:00:00 31/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [06:00:00 31/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [06:00:00 31/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [07:00:00 31/01/2016] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 200 u1: units st: NotStopd t0: [07:00:00 31/01/2016] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 200 u1: units st: NotStopd t0: [07:00:00 31/01/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [07:00:00 31/01/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.12 u1: L st: NotStopd
t0: [08:00:00 31/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:00:00 31/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10.9375 u1: ml/cmH st: NotStopd t0: [08:00:00 31/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 31/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 31/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [08:00:00 31/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [08:00:00 31/01/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:4.5 st: NotStopd t0: [08:00:00 31/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 31/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 31/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 31/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 31/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 31/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 31/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 31/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 31/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.6 u1: L/min st: NotStopd t0: [08:00:00 31/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 31/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 31/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 37 u1: cmH2O st: NotStopd t0: [08:00:00 31/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 12 u1: BPM st: NotStopd t0: [08:00:00 31/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [08:00:00 31/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 31/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [08:00:00 31/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 367 u1: ml/B st: NotStopd t0: [08:00:00 31/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [08:00:00 31/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 31/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 31/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 31/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 31/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 31/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 31/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [08:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [08:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [08:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [08:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [09:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [09:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 107.667 u1: mmHg st: NotStopd t0: [09:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [09:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml t0: [09:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [08:00:00 31/01/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 31/01/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 31/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [08:00:00 31/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [08:00:00 31/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [10:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [10:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [10:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [10:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [10:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [11:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [11:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 31/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 31/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 31/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 31/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [08:00:00 31/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [08:00:00 31/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [08:00:00 31/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 31/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 31/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 31/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 31/01/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 31/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 31/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 31/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 31/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [08:00:00 31/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [08:00:00 31/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 31/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 31/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 31/01/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Normal Saline st: NotStopd t0: [08:00:00 31/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 31/01/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serosanguinous v2: Small st: NotStopd t0: [08:00:00 31/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 31/01/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [08:00:00 31/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 31/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 31/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 31/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 31/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 31/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 31/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 31/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 31/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [08:00:00 31/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 31/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 31/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 31/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 31/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 31/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 31/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [08:00:00 31/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [08:00:00 31/01/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 31/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [08:00:00 31/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 31/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 31/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 31/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal st: NotStopd t0: [08:00:00 31/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 31/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 31/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 31/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 31/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [08:00:00 31/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 31/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 31/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 31/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 31/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 31/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 31/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 31/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 31/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 31/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 31/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 31/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 31/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 31/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 31/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 31/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [08:00:00 31/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [10:00:00 31/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [10:00:00 31/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [10:00:00 31/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 31/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 31/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [10:00:00 31/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [10:00:00 31/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 31/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [10:00:00 31/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 31/01/2016] id: Bath el: 1 cu: MICU cg: RN v1: done
t0: [11:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
tf: [10:00:00 01/02/2016] pt: Unit Dose rt: PO fr: ONCE fs: 11 dn: 1 m1: Neutra-Phos v1: 2 u1: PKT
t0: [12:00:00 31/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10.6061 u1: ml/cmH st: NotStopd t0: [12:00:00 31/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 31/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [12:00:00 31/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [12:00:00 31/01/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:4.5 st: NotStopd t0: [12:00:00 31/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 31/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 31/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 31/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 31/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 31/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 31/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 31/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:00:00 31/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.8 u1: L/min st: NotStopd t0: [12:00:00 31/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 31/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 31/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 38 u1: cmH2O st: NotStopd t0: [12:00:00 31/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [12:00:00 31/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:00:00 31/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:00:00 31/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:00:00 31/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thin st: NotStopd t0: [12:00:00 31/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [12:00:00 31/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 357 u1: ml/B st: NotStopd t0: [12:00:00 31/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [12:00:00 31/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:00:00 31/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 31/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [12:00:00 31/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 117 rs: Manual st: NotStopd
t0: [12:16:00 31/01/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.51 rs: Final st: NotStopd t0: [12:16:00 31/01/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 11 rs: Final st: NotStopd t0: [12:16:00 31/01/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 37 rs: Final st: NotStopd t0: [12:16:00 31/01/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 45 u1: mmHg rs: Final st: NotStopd t0: [12:16:00 31/01/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 143 u1: mmHg rs: Final st: NotStopd t0: [12:16:00 31/01/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.51 rs: Final st: NotStopd
t0: [12:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 31/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 31/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 31/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 31/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [12:00:00 31/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [12:00:00 31/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [12:00:00 31/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 31/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 31/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 31/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [12:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 31/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 31/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 31/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 31/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [12:00:00 31/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [12:00:00 31/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 31/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 31/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 31/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [12:00:00 31/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 31/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 31/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 31/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:00:00 31/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [12:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102.667 u1: mmHg st: NotStopd t0: [12:00:00 31/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 31/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 31/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [12:00:00 31/01/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 31/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 31/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [12:00:00 31/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal st: NotStopd t0: [12:00:00 31/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 31/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 31/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [12:00:00 31/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 31/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 31/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 31/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [12:00:00 31/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [12:00:00 31/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [12:00:00 31/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 31/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 31/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 31/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:30:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:30:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:30:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:30:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [12:30:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:30:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [12:30:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 109.667 u1: mmHg st: NotStopd t0: [12:30:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:30:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [12:30:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [12:30:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [13:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 129 u1: BPM st: NotStopd t0: [13:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 97 u2: mmHg st: NotStopd t0: [13:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [13:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 46 u1: BPM st: NotStopd t0: [13:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [13:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [13:00:00 31/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [13:00:00 31/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd
t0: [14:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [14:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 31/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 31/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [14:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [14:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [14:00:00 31/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 31/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 31/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [14:00:00 31/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [14:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 31/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [14:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [14:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 31/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [14:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [15:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [15:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [15:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [15:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 31/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [15:00:00 31/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [15:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 31/01/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml t0: [15:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [16:00:00 31/01/2016] id: INV Line#2SiteAppear el: 0 cu: MICU cg: -1 st: D/C'd
t0: [16:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 31/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 31/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 31/01/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 31/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 31/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 31/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [16:00:00 31/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 31/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 31/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 31/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 31/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [16:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 31/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 31/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 31/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 31/01/2016] id: INV Line#2 D/C Date el: 0 cu: MICU cg: RN v1: 2 v2: 1 st: NotStopd t0: [16:00:00 31/01/2016] id: INV Line#2 Type/Site el: 0 cu: MICU cg: RN v1: Multi-lumen v2: Left IJ st: NotStopd t0: [16:00:00 31/01/2016] id: INV Line#2InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 26 st: NotStopd t0: [16:00:00 31/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 31/01/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 31/01/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 31/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 31/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [16:00:00 31/01/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 31/01/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 31/01/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 31/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 31/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 31/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 31/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [16:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 106.333 u1: mmHg st: NotStopd t0: [16:00:00 31/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 31/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 31/01/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 31/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [16:00:00 31/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 31/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [16:00:00 31/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal st: NotStopd t0: [16:00:00 31/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 31/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 31/01/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 31/01/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [16:00:00 31/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [16:00:00 31/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 31/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 31/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 31/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [16:00:00 31/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [16:00:00 31/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 31/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 31/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 31/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 31/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 31/01/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 31/01/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [16:00:00 31/01/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 31/01/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 31/01/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [16:00:00 31/01/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 10 u1: number st: NotStopd t0: [16:00:00 31/01/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [17:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [17:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [17:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 31/01/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [17:00:00 31/01/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [17:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [23:00:00 31/01/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 250 ap: none
t0: [17:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [17:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd
t0: [17:00:00 31/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [17:00:00 31/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10.7143 u1: ml/cmH st: NotStopd t0: [17:00:00 31/01/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [17:00:00 31/01/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 31/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [17:00:00 31/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [17:00:00 31/01/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:4.5 st: NotStopd t0: [17:00:00 31/01/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [17:00:00 31/01/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [17:00:00 31/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 31/01/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 31/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [17:00:00 31/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 31/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [17:00:00 31/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 14.3 u1: L/min st: NotStopd t0: [17:00:00 31/01/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 31/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 31/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [17:00:00 31/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [17:00:00 31/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [17:00:00 31/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [17:00:00 31/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [17:00:00 31/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 293 u1: ml/B st: NotStopd t0: [17:00:00 31/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [17:00:00 31/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [17:00:00 31/01/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [17:00:00 31/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [17:00:00 31/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [17:00:00 31/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [17:00:00 31/01/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 31/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [18:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 31/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [18:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 31/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 31/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [18:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [18:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.3333 u1: mmHg st: NotStopd t0: [18:00:00 31/01/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 31/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 31/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [18:00:00 31/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 31/01/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [18:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [18:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 31/01/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [18:00:00 31/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [18:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 31/01/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 118 rs: Manual st: NotStopd
t0: [18:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [20:00:00 31/01/2016] id: Trach Insert Date el: 0 cu: MICU cg: CRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 31/01/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 10 u1: ml/cmH st: NotStopd t0: [20:00:00 31/01/2016] id: Cuff Leak el: 0 cu: MICU cg: CRT v1: No st: NotStopd t0: [20:00:00 31/01/2016] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 31/01/2016] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 31/01/2016] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 31/01/2016] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:3.6 st: NotStopd t0: [20:00:00 31/01/2016] id: Airway Size el: 0 cu: MICU cg: CRT v1: 8.0 mm st: NotStopd t0: [20:00:00 31/01/2016] id: Airway Type el: 0 cu: MICU cg: CRT v1: Tracheostomy st: NotStopd t0: [20:00:00 31/01/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 31/01/2016] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 31/01/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 5 st: NotStopd t0: [20:00:00 31/01/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 31/01/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 31/01/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 15 u1: cmH2O st: NotStopd t0: [20:00:00 31/01/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 8.7 u1: L/min st: NotStopd t0: [20:00:00 31/01/2016] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 31/01/2016] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [20:00:00 31/01/2016] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [20:00:00 31/01/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 35 u1: cmH2O st: NotStopd t0: [20:00:00 31/01/2016] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 33 u1: cmH2O st: NotStopd t0: [20:00:00 31/01/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 7 u1: BPM st: NotStopd t0: [20:00:00 31/01/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 27 u1: BPM st: NotStopd t0: [20:00:00 31/01/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 31/01/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: CRT v1: 99 u1: % st: NotStopd t0: [20:00:00 31/01/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 313 u1: ml/B st: NotStopd t0: [20:00:00 31/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 31/01/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: CRT v1: Yes v2: No st: NotStopd t0: [20:00:00 31/01/2016] id: Trach Size el: 0 cu: MICU cg: CRT v1: #8 st: NotStopd t0: [20:00:00 31/01/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: CRT v1: Inflated st: NotStopd t0: [20:00:00 31/01/2016] id: Tracheostomy Type el: 0 cu: MICU cg: CRT v1: Portex st: NotStopd t0: [20:00:00 31/01/2016] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [20:00:00 31/01/2016] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [20:00:00 31/01/2016] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [19:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [19:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [19:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [19:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [19:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 31/01/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 31/01/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [20:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [20:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [20:00:00 31/01/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [20:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [20:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [20:30:00 31/01/2016] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [20:30:00 31/01/2016] id: Airway Size el: 0 cu: MICU cg: CRT v1: 8.0 mm st: NotStopd t0: [20:30:00 31/01/2016] id: Airway Type el: 0 cu: MICU cg: CRT v1: Tracheostomy st: NotStopd t0: [20:30:00 31/01/2016] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [20:30:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: CRT v1: 100 u1: % st: NotStopd t0: [20:30:00 31/01/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 250 u1: ml/B st: NotStopd t0: [20:30:00 31/01/2016] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd
t0: [20:00:00 31/01/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 31/01/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 31/01/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 31/01/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 31/01/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [20:00:00 31/01/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 31/01/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 31/01/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 31/01/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 31/01/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 31/01/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 31/01/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 31/01/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 31/01/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 31/01/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 31/01/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [20:00:00 31/01/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 31/01/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 31/01/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 31/01/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 31/01/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 31/01/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 31/01/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 31/01/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [20:00:00 31/01/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 31/01/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 31/01/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal st: NotStopd t0: [20:00:00 31/01/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 31/01/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 31/01/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [20:00:00 31/01/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 31/01/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 31/01/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 31/01/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 31/01/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [20:00:00 31/01/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [20:00:00 31/01/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 31/01/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 31/01/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 31/01/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 31/01/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [21:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 31/01/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 90 u1: BPM st: NotStopd t0: [21:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 31/01/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 31/01/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [21:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103.667 u1: mmHg st: NotStopd t0: [21:00:00 31/01/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 31/01/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 31/01/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [21:00:00 31/01/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 31/01/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 31/01/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [10:00:00 05/02/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 12.5 u1: mg
t0: [22:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 92 u1: BPM st: NotStopd t0: [22:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [22:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104.333 u1: mmHg st: NotStopd t0: [22:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 42 u1: BPM st: NotStopd t0: [22:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 31/01/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 31/01/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 31/01/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 31/01/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 31/01/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 31/01/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [23:00:00 31/01/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 31/01/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [23:00:00 31/01/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103.333 u1: mmHg st: NotStopd t0: [23:00:00 31/01/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 31/01/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [23:00:00 31/01/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 31/01/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 01/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [00:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [00:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103.333 u1: mmHg st: NotStopd t0: [00:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [00:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 31/01/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [00:00:00 01/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 200 vu: ml t0: [00:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 31/01/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 30 cv: 30 ap: none t0: [23:00:00 31/01/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 45 cv: 45 ap: none t0: [23:00:00 31/01/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 75 cv: 2775 ap: none t0: [23:00:00 31/01/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1875 ap: none t0: [23:00:00 31/01/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 30 cv: 1960 ap: none t0: [23:00:00 31/01/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 45 cv: 615 ap: none t0: [23:00:00 31/01/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 30 cv: 2160 ap: none t0: [23:00:00 31/01/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 45 cv: 8777.54 ap: carryForward t0: [23:00:00 01/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 1210 ap: none
t0: [00:00:00 01/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: CRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 01/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 15.625 u1: ml/cmH st: NotStopd t0: [00:00:00 01/02/2016] id: Cuff Leak el: 0 cu: MICU cg: CRT v1: No st: NotStopd t0: [00:00:00 01/02/2016] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 01/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 01/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 40 u1: BPM st: NotStopd t0: [00:00:00 01/02/2016] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:3.6 st: NotStopd t0: [00:00:00 01/02/2016] id: Airway Size el: 0 cu: MICU cg: CRT v1: 8.0 mm st: NotStopd t0: [00:00:00 01/02/2016] id: Airway Type el: 0 cu: MICU cg: CRT v1: Tracheostomy st: NotStopd t0: [00:00:00 01/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 01/02/2016] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 01/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 5 st: NotStopd t0: [00:00:00 01/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 01/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 01/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 01/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 11.7 u1: L/min st: NotStopd t0: [00:00:00 01/02/2016] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 01/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [00:00:00 01/02/2016] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [00:00:00 01/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 21 u1: cmH2O st: NotStopd t0: [00:00:00 01/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 22 u1: cmH2O st: NotStopd t0: [00:00:00 01/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 1 u1: BPM st: NotStopd t0: [00:00:00 01/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 21 u1: BPM st: NotStopd t0: [00:00:00 01/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 01/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 01/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 251 u1: ml/B st: NotStopd t0: [00:00:00 01/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 250 u1: ml/B st: NotStopd t0: [00:00:00 01/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: CRT v1: Yes v2: No st: NotStopd t0: [00:00:00 01/02/2016] id: Trach Size el: 0 cu: MICU cg: CRT v1: #8 st: NotStopd t0: [00:00:00 01/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: CRT v1: Inflated st: NotStopd t0: [00:00:00 01/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: CRT v1: Portex st: NotStopd t0: [00:00:00 01/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [00:00:00 01/02/2016] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [00:00:00 01/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [00:00:00 01/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 01/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [00:00:00 01/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [01:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [01:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [01:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [01:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [01:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [02:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [02:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103.667 u1: mmHg st: NotStopd t0: [02:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 43 u1: BPM st: NotStopd t0: [02:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [23:00:00 01/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 320 cv: 320 ap: none t0: [23:00:00 01/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 320 cv: 2480 ap: none t0: [23:00:00 01/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 320 cv: 3180 ap: none
t0: [00:00:00 01/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 01/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 01/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 01/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 01/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [00:00:00 01/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 01/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 01/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 01/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 01/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 01/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 01/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 01/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 01/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 01/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 01/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 01/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 01/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 01/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 01/02/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [00:00:00 01/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 01/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 01/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 01/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 01/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 01/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 01/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 01/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 01/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 01/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 01/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 01/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [00:00:00 01/02/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [00:00:00 01/02/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [00:00:00 01/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 01/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 01/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 01/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 01/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 01/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [00:00:00 01/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 01/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 01/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 01/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 01/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 01/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 01/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 01/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 01/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 01/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 01/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 01/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 01/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 01/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 01/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 01/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 01/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [00:00:00 01/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [03:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [03:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 01/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [03:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [03:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [03:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [03:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 01/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -245 cv: -245 ap: none t0: [23:00:00 01/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 75 cv: 3485 ap: none t0: [23:00:00 01/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1725 ap: none t0: [23:00:00 01/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -245 cv: 305 ap: none t0: [23:00:00 01/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -245 cv: 9082.54 ap: carryForward
t0: [04:00:00 01/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: CRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 01/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 10.8696 u1: ml/cmH st: NotStopd t0: [04:00:00 01/02/2016] id: Cuff Leak el: 0 cu: MICU cg: CRT v1: No st: NotStopd t0: [04:00:00 01/02/2016] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 01/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 01/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 40 u1: BPM st: NotStopd t0: [04:00:00 01/02/2016] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:3.6 st: NotStopd t0: [04:00:00 01/02/2016] id: Airway Size el: 0 cu: MICU cg: CRT v1: 8.0 mm st: NotStopd t0: [04:00:00 01/02/2016] id: Airway Type el: 0 cu: MICU cg: CRT v1: Tracheostomy st: NotStopd t0: [04:00:00 01/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35.1 u1: Deg. C st: NotStopd t0: [04:00:00 01/02/2016] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 01/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 5 st: NotStopd t0: [04:00:00 01/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 01/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 01/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 14 u1: cmH2O st: NotStopd t0: [04:00:00 01/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 11 u1: L/min st: NotStopd t0: [04:00:00 01/02/2016] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 01/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [04:00:00 01/02/2016] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [04:00:00 01/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 28 u1: cmH2O st: NotStopd t0: [04:00:00 01/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 20 u1: cmH2O st: NotStopd t0: [04:00:00 01/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 25 u1: BPM st: NotStopd t0: [04:00:00 01/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 45 u1: BPM st: NotStopd t0: [04:00:00 01/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 01/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 13 u1: cmH2O st: NotStopd t0: [04:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: CRT v1: 99 u1: % st: NotStopd t0: [04:00:00 01/02/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: CRT v1: 44 u1: BPM st: NotStopd t0: [04:00:00 01/02/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: CRT v1: 0.158 u1: L st: NotStopd t0: [04:00:00 01/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 245 u1: ml/B st: NotStopd t0: [04:00:00 01/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 250 u1: ml/B st: NotStopd t0: [04:00:00 01/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: CRT v1: Yes v2: No st: NotStopd t0: [04:00:00 01/02/2016] id: Trach Size el: 0 cu: MICU cg: CRT v1: #8 st: NotStopd t0: [04:00:00 01/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: CRT v1: Inflated st: NotStopd t0: [04:00:00 01/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: CRT v1: Portex st: NotStopd t0: [04:00:00 01/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [04:00:00 01/02/2016] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [04:00:00 01/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [03:00:00 01/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [03:00:00 01/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 01/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 01/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 01/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 01/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 01/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 01/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [04:00:00 01/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 01/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 01/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 01/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 01/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 01/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [04:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 01/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 01/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 01/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 01/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 01/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 01/02/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [04:00:00 01/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 01/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 01/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 01/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 01/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [04:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [04:00:00 01/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 01/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 01/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 01/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 01/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 01/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 01/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 01/02/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [04:00:00 01/02/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [04:00:00 01/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 01/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 43 u1: BPM st: NotStopd t0: [04:00:00 01/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 01/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 01/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 01/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [04:00:00 01/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 01/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 01/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 01/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 01/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 01/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 01/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 01/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 01/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 01/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [04:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [04:00:00 01/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 01/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [04:00:00 01/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [04:00:00 01/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 01/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done t0: [05:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [05:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [05:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [05:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 43 u1: BPM st: NotStopd t0: [05:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 87 u1: % st: NotStopd t0: [05:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 01/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 200 vu: ml t0: [05:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [05:00:00 01/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 14.6 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 14.6 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 24.3 u1: % rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 6.9 u1: gm/dl rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 410 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.55 u1: /mic l rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 14.6 rs: Final st: NotStopd
t0: [05:00:00 01/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Albumin Chemistry el: 0 cu: MICU cg: 1663 v1: 2.7 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.5 u1: mg/dl rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 115 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 u1: mEq/L rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 149 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Albumin (>3.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.7 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 154 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.5 u1: mg/dl rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 34 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 115 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 u1: mEq/L rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 149 rs: Final st: NotStopd t0: [05:00:00 01/02/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd
t0: [06:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [06:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [06:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105.667 u1: mmHg st: NotStopd t0: [06:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 39 u1: BPM st: NotStopd t0: [06:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [06:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [08:00:00 01/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 01/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 01/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 01/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 01/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 01/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 01/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 01/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 01/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 01/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [08:00:00 01/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 01/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 01/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 01/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 01/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 01/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [08:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 01/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 01/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 01/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 01/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [08:00:00 01/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 01/02/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [08:00:00 01/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 01/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 01/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 01/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 01/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [08:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104.333 u1: mmHg st: NotStopd t0: [08:00:00 01/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 01/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 01/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 01/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 01/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 01/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 01/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [08:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 01/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [08:00:00 01/02/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 01/02/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 4 mm v2: 4 mm st: NotStopd t0: [08:00:00 01/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 01/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 01/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 45 u1: BPM st: NotStopd t0: [08:00:00 01/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 01/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 01/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 01/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 01/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [08:00:00 01/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [08:00:00 01/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [08:00:00 01/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 01/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 01/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 01/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 01/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [08:00:00 01/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [08:00:00 01/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 01/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 01/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 01/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 01/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 01/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 01/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 01/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 01/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 01/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 01/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 01/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [08:00:00 01/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 10 u1: number st: NotStopd t0: [08:00:00 01/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [08:00:00 01/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 60 vu: ml t0: [08:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [08:00:00 01/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 01/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 01/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd
t0: [08:00:00 01/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 01/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 01/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 01/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [08:00:00 01/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 01/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 01/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 01/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 01/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 01/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 01/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:15:00 01/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:15:00 01/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:15:00 01/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd
t0: [08:00:00 01/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10.8696 u1: ml/cmH st: NotStopd t0: [08:00:00 01/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 01/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:00:00 01/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [08:00:00 01/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 01/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 01/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 01/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 01/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [08:00:00 01/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [08:00:00 01/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 01/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 01/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [08:00:00 01/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [08:00:00 01/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [08:00:00 01/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 48 u1: BPM st: NotStopd t0: [08:00:00 01/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 01/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 01/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 240 u1: ml/B st: NotStopd t0: [08:00:00 01/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd
t0: [09:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [09:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [09:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [09:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 42 u1: BPM st: NotStopd t0: [09:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:30:00 01/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:30:00 01/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:30:00 01/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [09:30:00 01/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:30:00 01/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:30:00 01/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [09:30:00 01/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:30:00 01/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [09:30:00 01/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:30:00 01/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [09:30:00 01/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [09:30:00 01/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [09:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [11:00:00 02/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 12 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [10:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [10:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [10:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.3333 u1: mmHg st: NotStopd t0: [10:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 01/02/2016] id: Procedures el: 0 cu: MICU cg: RN v1: Fluoroscopy st: NotStopd t0: [10:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [10:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 01/02/2016] id: Procedures el: 0 cu: MICU cg: RN v1: Ultrasound st: NotStopd t0: [12:00:00 01/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 01/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 01/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Hemodyn Issue st: NotStopd t0: [12:00:00 01/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 01/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 01/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 01/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [12:00:00 01/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 01/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 01/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 01/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 01/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [12:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 01/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 01/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 01/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 01/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 01/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 01/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 158 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [12:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.3333 u1: mmHg st: NotStopd t0: [12:00:00 01/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 01/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 01/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 01/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 01/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 01/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [12:00:00 01/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 01/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [12:00:00 01/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [12:00:00 01/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [12:00:00 01/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 01/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 01/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 01/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38 u1: Deg. C st: NotStopd t0: [12:00:00 01/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.4 u1: Deg. F st: NotStopd t0: [12:00:00 01/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 01/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 01/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 01/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [12:00:00 01/02/2016] tf: [10:00:00 04/02/2016] dt: 4200 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml st: Stopped t0: [12:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml st: Restart
t0: [12:00:00 01/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 01/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 01/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 01/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 01/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 01/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [12:00:00 01/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 01/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 01/02/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [12:00:00 01/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [12:00:00 01/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 01/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 01/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 01/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 01/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 01/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [12:00:00 01/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 01/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [12:00:00 01/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 01/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 01/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 01/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 01/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 01/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [12:00:00 01/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 01/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd
t0: [12:00:00 01/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [12:00:00 01/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 11.1111 u1: ml/cmH st: NotStopd t0: [12:00:00 01/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 01/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 01/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [12:00:00 01/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [12:00:00 01/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 01/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 01/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 01/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 01/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 01/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.9 u1: L/min st: NotStopd t0: [12:00:00 01/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 01/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 01/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [12:00:00 01/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [12:00:00 01/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 9 u1: BPM st: NotStopd t0: [12:00:00 01/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [12:00:00 01/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:00:00 01/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:00:00 01/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [12:00:00 01/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:00:00 01/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 01/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:00:00 01/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:00:00 01/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:00:00 01/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 01/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
tf: [12:00:00 02/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 13 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml
t0: [12:00:00 01/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 113 rs: Manual st: NotStopd t0: [13:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [13:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [13:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.667 u1: mmHg st: NotStopd t0: [13:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [13:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [14:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [14:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101 u1: mmHg st: NotStopd t0: [14:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [14:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 01/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml t0: [13:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [15:00:00 01/02/2016] id: Edema Location/Amt#1 el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 01/02/2016] id: ImpSkin Character #2 el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 01/02/2016] id: ImpSkin Drain/Amt#2 el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 01/02/2016] id: ImpSkin Treatment #2 el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 01/02/2016] id: Inc Closure/Appear#1 el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 01/02/2016] id: Inc Drainage/Amt #1 el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 01/02/2016] id: Inc Dsg/Status #1 el: 0 cu: MICU cg: -1 st: D/C'd t0: [15:00:00 01/02/2016] id: Incision/Wound #1 el: 0 cu: MICU cg: -1 st: D/C'd
t0: [15:00:00 01/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [15:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 01/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 01/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [15:00:00 01/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [15:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 01/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [15:00:00 01/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [15:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 01/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [15:00:00 01/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 01/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [15:00:00 01/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [15:00:00 01/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [15:00:00 01/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [15:00:00 01/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [15:00:00 01/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [15:00:00 01/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [15:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [15:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 01/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 01/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [15:00:00 01/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 01/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [15:00:00 01/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [15:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 89 u2: mmHg st: NotStopd t0: [15:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 110.667 u1: mmHg st: NotStopd t0: [15:00:00 01/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [15:00:00 01/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [15:00:00 01/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [15:00:00 01/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [15:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 01/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 01/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [15:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [15:00:00 01/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [15:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 01/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [15:00:00 01/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [15:00:00 01/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [15:00:00 01/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [15:00:00 01/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [15:00:00 01/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [15:00:00 01/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.9444 u1: Deg. C st: NotStopd t0: [15:00:00 01/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.3 u1: Deg. F st: NotStopd t0: [15:00:00 01/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [15:00:00 01/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [15:00:00 01/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [15:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 01/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [15:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [15:00:00 01/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 01/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [15:00:00 01/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [15:00:00 01/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [15:00:00 01/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 01/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [15:00:00 01/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [15:00:00 01/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [15:00:00 01/02/2016] id: Impaired Skin Site#2 el: 0 cu: MICU cg: RN v1: Chest st: NotStopd t0: [15:00:00 01/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [15:00:00 01/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 01/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 01/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [15:00:00 01/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 01/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 01/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [15:00:00 01/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [15:00:00 01/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [15:00:00 01/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 01/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [15:00:00 01/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [15:00:00 01/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [15:00:00 01/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [15:00:00 01/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [15:00:00 01/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Cooperative st: NotStopd
t0: [16:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [16:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [16:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105.333 u1: mmHg st: NotStopd t0: [16:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [16:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [16:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [16:30:00 01/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [16:30:00 01/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:30:00 01/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [16:30:00 01/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [16:30:00 01/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [17:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [17:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 165 u1: mmHg v2: 93 u2: mmHg st: NotStopd t0: [17:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 117 u1: mmHg st: NotStopd t0: [17:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [17:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [17:00:00 01/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [17:00:00 01/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10 u1: ml/cmH st: NotStopd t0: [17:00:00 01/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [17:00:00 01/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 01/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [17:00:00 01/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [17:00:00 01/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [17:00:00 01/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 01/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 01/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v2: Albuterol st: NotStopd t0: [17:00:00 01/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v2: Atrovent st: NotStopd t0: [17:00:00 01/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [17:00:00 01/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [17:00:00 01/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 01/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [17:00:00 01/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [17:00:00 01/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 23 u1: BPM st: NotStopd t0: [17:00:00 01/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 43 u1: BPM st: NotStopd t0: [17:00:00 01/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [17:00:00 01/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [17:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 01/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Clear v2: Thin st: NotStopd t0: [17:00:00 01/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [17:00:00 01/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [17:00:00 01/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [17:00:00 01/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [17:00:00 01/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [17:00:00 01/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [17:00:00 01/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [17:00:00 01/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 01/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [23:00:00 01/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RRT cv: 700 ap: none
tf: [17:00:00 02/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 18 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [18:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 89 u1: BPM st: NotStopd t0: [18:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [18:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [18:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 01/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.9444 u1: Deg. C st: NotStopd t0: [18:00:00 01/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.3 u1: Deg. F st: NotStopd t0: [18:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 01/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml t0: [18:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [18:17:00 01/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 29 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 110 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 111 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 u1: mEq/L rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 148 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 29 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 110 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 111 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 u1: mEq/L rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [18:17:00 01/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 148 rs: Final st: NotStopd
t0: [20:00:00 01/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [20:00:00 01/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10 u1: ml/cmH st: NotStopd t0: [20:00:00 01/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 01/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 01/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 01/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [20:00:00 01/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 01/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 01/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 01/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 01/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 01/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 01/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 01/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [20:00:00 01/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [20:00:00 01/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 01/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 01/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [20:00:00 01/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [20:00:00 01/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [20:00:00 01/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 01/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:00:00 01/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [20:00:00 01/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 01/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 01/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 01/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 01/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 01/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 01/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 01/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [19:00:00 01/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [19:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 01/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [19:00:00 01/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [19:00:00 01/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [19:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 01/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [19:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 01/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [19:00:00 01/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [19:00:00 01/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [19:00:00 01/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [19:00:00 01/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [19:00:00 01/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [19:00:00 01/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [19:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [19:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 01/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [19:00:00 01/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [19:00:00 01/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [19:00:00 01/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [19:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 158 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [19:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 112.667 u1: mmHg st: NotStopd t0: [19:00:00 01/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [19:00:00 01/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [19:00:00 01/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [19:00:00 01/02/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 01/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [19:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [19:00:00 01/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [19:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 01/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [19:00:00 01/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [19:00:00 01/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [19:00:00 01/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [19:00:00 01/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [19:00:00 01/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [19:00:00 01/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [19:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [19:00:00 01/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 01/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 01/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 01/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 01/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 01/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 01/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 01/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 01/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 01/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 01/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 01/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 01/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 01/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 01/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 01/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd
t0: [19:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [20:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [20:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 01/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [20:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [20:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [20:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.3333 u1: mmHg st: NotStopd t0: [20:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [20:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
tf: [20:00:00 02/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 21 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [21:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 01/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [21:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [21:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.6667 u1: mmHg st: NotStopd t0: [21:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [21:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [21:00:00 01/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [21:00:00 01/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [21:00:00 01/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [21:00:00 01/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [21:00:00 01/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [21:00:00 01/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [21:00:00 01/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [21:00:00 01/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 01/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 01/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 01/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [21:00:00 01/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 01/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 01/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 01/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 01/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [21:00:00 01/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [21:00:00 01/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [21:00:00 01/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 01/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd
t0: [21:00:00 01/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [21:00:00 01/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd
t0: [23:00:00 01/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 550 ap: none
t0: [22:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 01/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [22:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [22:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [22:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [22:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 01/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [22:00:00 01/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.9444 u1: Deg. C st: NotStopd t0: [22:00:00 01/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.3 u1: Deg. F st: NotStopd t0: [22:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
tf: [21:00:00 02/02/2016] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Neutra-Phos v1: 1 u1: PKT
t0: [22:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 01/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 01/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 01/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [23:00:00 01/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 01/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 01/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 01/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [23:00:00 01/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 01/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [23:00:00 01/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [23:00:00 01/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [23:00:00 01/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 01/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [23:00:00 01/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 01/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 01/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [00:00:00 02/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [00:00:00 02/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10.7143 u1: ml/cmH st: NotStopd t0: [00:00:00 02/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 02/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 02/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 02/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [00:00:00 02/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 02/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 02/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 02/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 02/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 02/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 02/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 02/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [00:00:00 02/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.5 u1: L/min st: NotStopd t0: [00:00:00 02/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 02/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 02/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [00:00:00 02/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [00:00:00 02/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [00:00:00 02/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 02/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:00:00 02/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 02/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 02/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 02/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 02/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 02/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 02/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 02/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 02/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 02/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 02/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 02/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 02/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 02/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [00:00:00 02/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [00:00:00 02/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 02/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 02/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 02/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [00:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 02/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 02/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 02/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 02/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 02/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 02/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 02/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 02/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [00:00:00 02/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 02/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 02/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 02/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 02/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 02/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 02/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [00:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103.333 u1: mmHg st: NotStopd t0: [00:00:00 02/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 02/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 02/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 02/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 02/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 39 u1: BPM st: NotStopd t0: [00:00:00 02/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 02/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 02/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 02/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 02/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [00:00:00 02/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 02/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 02/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 02/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 02/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 02/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 02/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [00:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 02/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 02/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [00:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [21:00:00 01/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml t0: [00:00:00 02/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml
t0: [23:00:00 02/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 1500 ap: none
t0: [22:00:00 01/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [22:00:00 01/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 02/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 02/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [20:00:00 01/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 01/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 01/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 01/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 01/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [23:00:00 01/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [23:00:00 01/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 01/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [23:00:00 01/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [23:00:00 01/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [23:00:00 01/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [23:00:00 01/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [23:00:00 01/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd
t0: [01:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 02/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [01:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [01:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [01:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [01:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [01:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 02/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [02:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [02:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [02:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [02:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [02:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 02/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 400 cv: 400 ap: none t0: [23:00:00 02/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 400 cv: 1875 ap: none t0: [23:00:00 02/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 400 cv: 2575 ap: none
t0: [02:00:00 02/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [02:00:00 02/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.9444 u1: Deg. C st: NotStopd t0: [02:00:00 02/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.3 u1: Deg. F st: NotStopd t0: [03:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 02/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [03:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [03:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [03:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.3333 u1: mmHg st: NotStopd t0: [03:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [03:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [03:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 02/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -315 cv: -315 ap: none t0: [23:00:00 02/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 85 cv: 3700 ap: none t0: [23:00:00 02/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1800 ap: none t0: [23:00:00 02/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -315 cv: 1125 ap: none t0: [23:00:00 02/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -315 cv: 10207.5 ap: carryForward
t0: [04:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 02/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [04:00:00 02/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 02/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 02/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [04:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 02/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 02/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [04:00:00 02/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 14 u1: points st: NotStopd t0: [04:00:00 02/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 02/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 02/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 02/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [04:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 02/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 02/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 02/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 02/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 02/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 02/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 02/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [04:00:00 02/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 02/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 02/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 02/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 02/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 02/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 02/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [04:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [04:00:00 02/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 02/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 02/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [04:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 02/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 02/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 02/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 02/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [04:00:00 02/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 02/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 02/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 02/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 02/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [04:00:00 02/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 02/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [04:00:00 02/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 02/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 02/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 02/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow st: NotStopd t0: [04:00:00 02/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 02/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [04:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 02/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 02/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [04:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [05:00:00 02/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [05:00:00 02/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10.3448 u1: ml/cmH st: NotStopd t0: [05:00:00 02/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [05:00:00 02/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [05:00:00 02/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [05:00:00 02/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [05:00:00 02/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [05:00:00 02/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [05:00:00 02/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:00:00 02/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 02/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [05:00:00 02/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:00:00 02/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:00:00 02/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [05:00:00 02/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.8 u1: L/min st: NotStopd t0: [05:00:00 02/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 02/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 02/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [05:00:00 02/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [05:00:00 02/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [05:00:00 02/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [05:00:00 02/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [05:00:00 02/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [05:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [05:00:00 02/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [05:00:00 02/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [05:00:00 02/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [05:00:00 02/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [05:00:00 02/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [05:00:00 02/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [05:00:00 02/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [05:00:00 02/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [05:00:00 02/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 02/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 14.8 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 14.8 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 22.4 u1: % rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 6.8 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 420 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.36 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 14.8 rs: Final st: NotStopd
t0: [04:00:00 02/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 26 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.3 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 145 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.6 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: 1 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 13 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 149 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 26 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.3 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 109 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 145 rs: Final st: NotStopd t0: [04:00:00 02/02/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.6 rs: Final st: NotStopd
t0: [05:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 02/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [05:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [05:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [05:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [05:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [05:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 02/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 02/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [06:00:00 02/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [06:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [06:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 02/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [06:00:00 02/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [06:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [06:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [06:00:00 02/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [06:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [06:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 02/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [06:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [06:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 02/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 700 ap: none
t0: [04:00:00 02/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml
t0: [04:00:00 02/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [06:00:00 02/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Normal Saline st: NotStopd t0: [06:00:00 02/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [06:00:00 02/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serosanguinous v2: Scant st: NotStopd t0: [06:00:00 02/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [06:00:00 02/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [06:00:00 02/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [06:00:00 02/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [06:00:00 02/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 02/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 02/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [06:00:00 02/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Diaphoretic st: NotStopd t0: [06:00:00 02/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd
io: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ra: 10 ru: ml/hr
id: .9% Normal Saline el: 2 cu: MICU cg: RN io: .9% Normal Saline 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push
t0: [08:00:00 02/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [08:00:00 02/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12 u1: ml/cmH st: NotStopd t0: [08:00:00 02/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 02/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 02/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:00:00 02/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [08:00:00 02/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 02/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 02/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 02/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 02/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 02/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 02/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 02/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [08:00:00 02/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [08:00:00 02/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 02/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 02/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [08:00:00 02/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [08:00:00 02/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 12 u1: BPM st: NotStopd t0: [08:00:00 02/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [08:00:00 02/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 02/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 02/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [08:00:00 02/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:00:00 02/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 02/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 02/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 02/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 02/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 02/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [07:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [07:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [07:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [07:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [07:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 02/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 02/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 02/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 02/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 02/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [08:00:00 02/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 02/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 02/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 02/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 02/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [08:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 02/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 02/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 02/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 02/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 02/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 02/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [08:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 82.6667 u1: mmHg st: NotStopd t0: [08:00:00 02/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 02/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 02/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 02/02/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [08:00:00 02/02/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [08:00:00 02/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 02/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 02/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [08:00:00 02/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 02/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [08:00:00 02/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [08:00:00 02/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [08:00:00 02/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 02/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 02/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.2222 u1: Deg. C st: NotStopd t0: [08:00:00 02/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.8 u1: Deg. F st: NotStopd t0: [08:00:00 02/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow st: NotStopd t0: [08:00:00 02/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 02/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 02/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [09:00:00 02/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 02/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [09:00:00 02/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [09:00:00 02/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [09:00:00 02/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 02/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 02/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [09:00:00 02/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [09:00:00 02/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN st: NotStopd t0: [09:00:00 02/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [09:00:00 02/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [09:00:00 02/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 02/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [09:00:00 02/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 02/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 02/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [09:00:00 02/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 02/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 02/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [09:00:00 02/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [09:00:00 02/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 02/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [09:00:00 02/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [09:00:00 02/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd
t0: [08:00:00 02/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 0 vu: ml nb: 1 t0: [08:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [09:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [09:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [09:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [09:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [09:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
tf: [11:00:00 02/02/2016] pt: IV Piggyback rt: SC fr: 3X/WEEK fs: 10 m1: Epoetin Alfa v1: 2000 u1: UNIT m2: Vial v2: 1 u2: VIAL tf: [11:00:00 02/02/2016] pt: IV Piggyback rt: SC fr: 3X/WEEK fs: 10 m1: Epoetin Alfa v1: 3000 u1: UNIT m2: Vial v2: 1 u2: VIAL tf: [11:00:00 06/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Warfarin v1: 1 u1: mg
t0: [10:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RRT v1: MICU st: NotStopd t0: [10:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RRT v1: Full Code st: NotStopd t0: [10:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RRT v1: Yes st: NotStopd t0: [10:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RRT v1: None st: NotStopd t0: [10:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RRT v1: None st: NotStopd t0: [10:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RRT v1: 91 u1: BPM st: NotStopd t0: [10:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RRT v1: Normal Sinus st: NotStopd t0: [10:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RRT v1: 135 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [10:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RRT v1: 91.6667 u1: mmHg st: NotStopd t0: [10:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RRT v1: Universal st: NotStopd t0: [10:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [10:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [10:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RRT v1: 1 u1: kg st: NotStopd t0: [12:00:00 02/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [12:00:00 02/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.5 u1: ml/cmH st: NotStopd t0: [12:00:00 02/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 02/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 02/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [12:00:00 02/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [12:00:00 02/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 02/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 02/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 02/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 02/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 02/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:00:00 02/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.8 u1: L/min st: NotStopd t0: [12:00:00 02/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 02/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 02/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [12:00:00 02/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [12:00:00 02/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 11 u1: BPM st: NotStopd t0: [12:00:00 02/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [12:00:00 02/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:00:00 02/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:00:00 02/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 307 u1: ml/B st: NotStopd t0: [12:00:00 02/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:00:00 02/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 02/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:00:00 02/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:00:00 02/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:00:00 02/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 02/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [11:00:00 02/02/2016] tf: [11:00:00 04/02/2016] dt: 2880 id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RRT ai: 107 vo: 30 vu: ml t0: [11:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RRT ai: 498 vo: 225 vu: ml
tf: [11:00:00 03/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 12 dn: 1 m1: Potassium Phosphate v1: 15 u1: mmol m2: NS v2: 250 u2: ml
t0: [11:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [11:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [11:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.6667 u1: mmHg st: NotStopd t0: [11:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [11:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 02/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 02/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 02/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 02/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [12:00:00 02/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [12:00:00 02/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 02/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 02/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 02/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 02/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [12:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 02/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 02/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 02/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 02/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 02/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 02/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 02/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 02/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 02/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 02/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 02/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 02/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 02/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 02/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [12:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [12:00:00 02/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 02/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 02/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 02/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [12:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 02/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [12:00:00 02/02/2016] id: Pupil Response R/L el: 0 cu: MICU cg: RN v1: Brisk v2: Brisk st: NotStopd t0: [12:00:00 02/02/2016] id: Pupil Size R/L el: 0 cu: MICU cg: RN v1: 3 mm v2: 3 mm st: NotStopd t0: [12:00:00 02/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 02/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 02/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [12:00:00 02/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 02/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 02/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 02/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 02/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 02/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [12:00:00 02/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [12:00:00 02/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [12:00:00 02/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 02/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 02/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [12:00:00 02/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [12:00:00 02/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow st: NotStopd t0: [12:00:00 02/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 02/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [12:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 02/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [12:00:00 02/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [13:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 109 u1: BPM st: NotStopd t0: [13:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Tachy st: NotStopd t0: [13:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [13:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [13:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 41 u1: BPM st: NotStopd t0: [13:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 02/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5 u1: Deg. C st: NotStopd t0: [13:00:00 02/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.5 u1: Deg. F st: NotStopd t0: [13:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [14:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [14:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [14:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [14:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [14:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 02/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [13:30:00 02/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 14.1 rs: Final st: NotStopd t0: [13:30:00 02/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [13:30:00 02/02/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 32.3 rs: Final st: NotStopd t0: [13:30:00 02/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [13:30:00 02/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14.1 rs: Final st: NotStopd t0: [13:30:00 02/02/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 32.3 rs: Final st: NotStopd
t0: [16:00:00 02/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [16:00:00 02/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 11.5385 u1: ml/cmH st: NotStopd t0: [16:00:00 02/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:00:00 02/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 02/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [16:00:00 02/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [16:00:00 02/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 02/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 02/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 02/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 02/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 02/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [16:00:00 02/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.6 u1: L/min st: NotStopd t0: [16:00:00 02/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 02/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 02/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [16:00:00 02/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [16:00:00 02/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [16:00:00 02/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [16:00:00 02/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [16:00:00 02/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:00:00 02/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 325 u1: ml/B st: NotStopd t0: [16:00:00 02/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [16:00:00 02/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:00:00 02/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:00:00 02/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:00:00 02/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:00:00 02/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 02/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [15:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [15:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 8 u1: BPM st: NotStopd t0: [15:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 92 u1: % st: NotStopd t0: [15:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 02/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 02/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 02/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 02/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 02/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 02/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [16:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 02/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 02/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 02/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 02/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 02/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 02/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 02/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 02/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [16:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [16:00:00 02/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 02/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 02/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [16:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 225 vu: ml
t0: [17:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [17:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [17:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105.333 u1: mmHg st: NotStopd t0: [17:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [17:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [18:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [18:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97.6667 u1: mmHg st: NotStopd t0: [18:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [18:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [19:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 93 u1: BPM st: NotStopd t0: [19:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [19:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 02/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml t0: [12:00:00 02/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml t0: [17:00:00 02/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml t0: [18:00:00 02/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [18:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [20:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [20:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [20:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.6667 u1: mmHg st: NotStopd t0: [20:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [20:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 02/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [20:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [21:00:00 02/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [21:00:00 02/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12 u1: ml/cmH st: NotStopd t0: [21:00:00 02/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [21:00:00 02/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [21:00:00 02/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [21:00:00 02/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [21:00:00 02/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [21:00:00 02/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [21:00:00 02/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [21:00:00 02/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [21:00:00 02/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [21:00:00 02/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [21:00:00 02/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [21:00:00 02/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [21:00:00 02/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.5 u1: L/min st: NotStopd t0: [21:00:00 02/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [21:00:00 02/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [21:00:00 02/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [21:00:00 02/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [21:00:00 02/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [21:00:00 02/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [21:00:00 02/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [21:00:00 02/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 325 u1: ml/B st: NotStopd t0: [21:00:00 02/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [21:00:00 02/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [21:00:00 02/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [21:00:00 02/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [21:00:00 02/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [21:00:00 02/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [21:00:00 02/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [21:00:00 02/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 02/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 02/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 02/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 02/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 02/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 02/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 02/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [20:00:00 02/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 02/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 02/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 02/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 02/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 02/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 02/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 02/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 02/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 02/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 02/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 02/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 02/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 02/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 02/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 02/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 02/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 02/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 02/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 02/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [20:00:00 02/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 02/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 02/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 02/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 02/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN u1: % st: NotStopd t0: [20:00:00 02/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [20:00:00 02/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 02/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 02/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 02/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 02/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 02/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 02/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 02/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 02/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [21:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [21:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [21:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [21:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [21:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN u1: % st: NotStopd t0: [21:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
tf: [21:00:00 03/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 22 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [20:00:00 02/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 02/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [20:00:00 02/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [22:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [22:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [22:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.333 u1: mmHg st: NotStopd t0: [22:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [22:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [22:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 02/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [22:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [22:00:00 02/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [22:00:00 02/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 02/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd
t0: [22:00:00 02/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml
t0: [23:00:00 02/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 02/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 02/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 02/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 02/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 02/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [23:00:00 02/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 02/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [23:00:00 02/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.6667 u1: mmHg st: NotStopd t0: [23:00:00 02/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 02/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [23:00:00 02/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 02/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 02/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 02/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 02/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 10 cv: 400 ap: none
t0: [23:00:00 02/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 24 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 114 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 u1: mEq/L rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 145 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 24 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 114 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 u1: mEq/L rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 rs: Final st: NotStopd t0: [23:00:00 02/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 145 rs: Final st: NotStopd
t0: [00:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [00:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [00:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [00:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [00:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [00:00:00 03/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [00:00:00 03/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15.7895 u1: ml/cmH st: NotStopd t0: [00:00:00 03/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 03/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 03/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 03/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [00:00:00 03/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 03/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 03/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 03/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 03/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 03/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [00:00:00 03/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.6 u1: L/min st: NotStopd t0: [00:00:00 03/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 03/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 03/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [00:00:00 03/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [00:00:00 03/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [00:00:00 03/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 03/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 03/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [00:00:00 03/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 03/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 03/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 03/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 03/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 03/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 03/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 03/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [01:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [01:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [01:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.6667 u1: mmHg st: NotStopd t0: [01:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [01:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [02:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [02:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [02:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.667 u1: mmHg st: NotStopd t0: [02:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [02:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [03:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [03:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [03:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [03:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [03:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 03/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 260 cv: 260 ap: none t0: [23:00:00 03/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -175 cv: -175 ap: none t0: [23:00:00 03/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 10 cv: 490 ap: none t0: [23:00:00 03/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 85 cv: 3065 ap: none t0: [23:00:00 03/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1800 ap: none t0: [23:00:00 03/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 260 cv: 2960 ap: none t0: [23:00:00 03/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -175 cv: -270 ap: none t0: [23:00:00 03/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 260 cv: 3335 ap: none t0: [23:00:00 03/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -175 cv: 9937.54 ap: carryForward
t0: [04:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [04:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [04:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.6667 u1: mmHg st: NotStopd t0: [04:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 42 u1: BPM st: NotStopd t0: [04:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [05:00:00 03/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v2: 23 st: NotStopd t0: [05:00:00 03/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 14.2857 u1: ml/cmH st: NotStopd t0: [05:00:00 03/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [05:00:00 03/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [05:00:00 03/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [05:00:00 03/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [05:00:00 03/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [05:00:00 03/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [05:00:00 03/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:00:00 03/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 03/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [05:00:00 03/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [05:00:00 03/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [05:00:00 03/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [05:00:00 03/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [05:00:00 03/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [05:00:00 03/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [05:00:00 03/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [05:00:00 03/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [05:00:00 03/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [05:00:00 03/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [05:00:00 03/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [05:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [05:00:00 03/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [05:00:00 03/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [05:00:00 03/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [05:00:00 03/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [05:00:00 03/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [05:00:00 03/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [05:00:00 03/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [05:00:00 03/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [05:00:00 03/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [05:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 03/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml t0: [05:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [20:00:00 02/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 02/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 02/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 02/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 02/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 02/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 02/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 02/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [22:00:00 02/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 02/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 02/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 02/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 02/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [22:00:00 02/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 02/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [22:00:00 02/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [22:00:00 02/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [22:00:00 02/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 03/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 03/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 03/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 03/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 03/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [00:00:00 03/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [00:00:00 03/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 03/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 03/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 03/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 03/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 03/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 03/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 03/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 03/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 03/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 03/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 03/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [00:00:00 03/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None v2: Scant st: NotStopd t0: [00:00:00 03/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 03/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 03/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 03/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 03/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 03/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 03/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 03/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 03/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 03/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 03/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 03/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 03/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 03/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 03/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [00:00:00 03/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 03/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 03/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 03/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 03/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 03/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [00:00:00 03/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 03/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 03/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 03/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 03/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 03/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 03/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 03/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [00:00:00 03/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [04:00:00 03/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 03/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 03/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 03/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 03/02/2016] id: Follows Commands el: 0 cu: MICU cg: RN v1: Consistently st: NotStopd t0: [04:00:00 03/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [04:00:00 03/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 03/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 03/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 03/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 03/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 03/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 03/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 03/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 03/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 03/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 03/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 03/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 03/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 03/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 03/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 03/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 03/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 03/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 03/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 03/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 03/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 03/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 03/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 03/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [04:00:00 03/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 03/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Multipodus Boots st: NotStopd t0: [04:00:00 03/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 03/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 03/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 03/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 03/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 03/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 03/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: RN v1: Purposeful st: NotStopd t0: [04:00:00 03/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 03/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 03/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 03/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 03/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 03/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 03/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 03/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [04:00:00 03/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 03/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 03/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [05:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [05:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [05:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.667 u1: mmHg st: NotStopd t0: [05:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [05:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:30:00 03/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.5 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 13.5 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 22 u1: % rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 434 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.5 rs: Final st: NotStopd
t0: [04:30:00 03/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 14 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 32.4 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 32.4 rs: Final st: NotStopd
t0: [00:00:00 03/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 03/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [00:00:00 03/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [06:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [06:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 41 u1: BPM st: NotStopd t0: [06:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:30:00 03/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8 u1: mg/dl rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 119 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 u1: mEq/L rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 144 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.5 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 15 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 165 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8 u1: mg/dl rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 29 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 119 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 u1: mEq/L rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 144 rs: Final st: NotStopd t0: [04:30:00 03/02/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.5 rs: Final st: NotStopd
t0: [06:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [06:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 110 u1: mmHg st: NotStopd t0: [06:00:00 03/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [06:00:00 03/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5556 u1: Deg. C st: NotStopd t0: [06:00:00 03/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.6 u1: Deg. F st: NotStopd
t0: [06:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [07:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [07:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN u1: mmHg v2: 0 u2: mmHg st: NotStopd t0: [07:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [07:00:00 03/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [07:00:00 03/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [07:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 03/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:00:00 03/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 9.67742 u1: ml/cmH st: NotStopd t0: [08:00:00 03/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 03/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 03/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:00:00 03/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 03/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.6 st: NotStopd t0: [08:00:00 03/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 03/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 03/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 03/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 03/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 9 st: NotStopd t0: [08:00:00 03/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [08:00:00 03/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.4 u1: L/min st: NotStopd t0: [08:00:00 03/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 03/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 03/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [08:00:00 03/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [08:00:00 03/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 22 u1: BPM st: NotStopd t0: [08:00:00 03/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [08:00:00 03/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 03/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 03/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [08:00:00 03/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 03/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [08:00:00 03/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:00:00 03/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 03/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 03/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 03/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 03/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 03/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 03/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 03/02/2016] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd
t0: [08:00:00 03/02/2016] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 200 u1: units st: NotStopd t0: [08:00:00 03/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 03/02/2016] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 200 u1: units st: NotStopd t0: [08:00:00 03/02/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [08:00:00 03/02/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.2 u1: L st: NotStopd
t0: [08:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd
t0: [08:00:00 03/02/2016] id: Follows Commands el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 03/02/2016] id: Arterial BP el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 03/02/2016] id: Arterial BP Mean el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 03/02/2016] id: Pupil Response R/L el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 03/02/2016] id: Pupil Size R/L el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 03/02/2016] id: Spontaneous Movement el: 0 cu: MICU cg: -1 st: D/C'd
t0: [08:00:00 03/02/2016] id: paracentesis el: 1 cu: MICU cg: -1 vo: 0 st: D/C'd t0: [08:00:00 03/02/2016] id: Gastric Nasogastric el: 1 cu: MICU cg: -1 vo: 0 st: D/C'd
tf: [07:00:00 04/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 8 dn: 1 m1: Bumetanide v1: 2 u1: mg m2: D5W v2: 50 u2: ml
t0: [08:05:00 03/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd
t0: [08:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 03/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 03/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 03/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 03/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 03/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 03/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 03/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 03/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 03/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 03/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 03/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 03/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [08:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 03/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 03/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 03/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 03/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 03/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 03/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 03/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 03/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 03/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 03/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 03/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 03/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 03/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 03/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 03/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [08:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 106.667 u1: mmHg st: NotStopd t0: [08:00:00 03/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 03/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 03/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:00:00 03/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 03/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 03/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 03/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 03/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 03/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [08:00:00 03/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 42 u1: BPM st: NotStopd t0: [08:00:00 03/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 03/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 03/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 03/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 03/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [08:00:00 03/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 03/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 03/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 03/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 03/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 03/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [08:00:00 03/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [08:00:00 03/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [08:00:00 03/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 03/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 03/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 03/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 03/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 03/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [08:00:00 03/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 03/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [08:00:00 03/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 03/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 03/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 03/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 03/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [08:00:00 03/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [09:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 03/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [09:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 03/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 03/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [09:00:00 03/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v2: Off st: NotStopd t0: [09:00:00 03/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [09:00:00 03/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 03/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [09:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 46 u1: BPM st: NotStopd t0: [09:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [09:00:00 03/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [09:00:00 03/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [09:00:00 03/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [09:00:00 03/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [09:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 03/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml t0: [09:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [10:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Occasional st: NotStopd t0: [10:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PAC's st: NotStopd t0: [10:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [10:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [10:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.3333 u1: mmHg st: NotStopd t0: [10:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [10:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [09:00:00 04/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 10 dn: 1 m1: Bumetanide v1: 2 u1: mg tf: [11:00:00 06/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Metolazone v1: 2.5 u1: mg
t0: [11:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 03/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [11:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Rare st: NotStopd t0: [11:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PAC's st: NotStopd t0: [11:00:00 03/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [11:00:00 03/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [11:00:00 03/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [11:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 96 u1: BPM st: NotStopd t0: [11:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 03/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [11:00:00 03/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [11:00:00 03/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [11:00:00 03/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 03/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [11:00:00 03/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [11:00:00 03/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serous v2: Scant st: NotStopd t0: [11:00:00 03/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [11:00:00 03/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [11:00:00 03/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [11:00:00 03/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip st: NotStopd t0: [11:00:00 03/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [11:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 89 u2: mmHg st: NotStopd t0: [11:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 114 u1: mmHg st: NotStopd t0: [11:00:00 03/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [11:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 03/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [11:00:00 03/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [11:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 44 u1: BPM st: NotStopd t0: [11:00:00 03/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 03/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [11:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 03/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [11:00:00 03/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [11:00:00 03/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [11:00:00 03/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [11:00:00 03/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [12:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Rare st: NotStopd t0: [12:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PAC's st: NotStopd t0: [12:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [12:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 89 u2: mmHg st: NotStopd t0: [12:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 113.333 u1: mmHg st: NotStopd t0: [12:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 44 u1: BPM st: NotStopd t0: [12:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 03/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 03/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.8333 u1: Deg. C st: NotStopd t0: [12:00:00 03/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.1 u1: Deg. F st: NotStopd t0: [12:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 03/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 112 rs: Manual st: NotStopd
t0: [12:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [12:00:00 03/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [12:00:00 03/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd
t0: [23:00:00 03/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 375 ap: none
t0: [12:12:00 03/02/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.46 rs: Final st: NotStopd t0: [12:12:00 03/02/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 7 rs: Final st: NotStopd t0: [12:12:00 03/02/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 142 u1: mmHg rs: Final st: NotStopd t0: [12:12:00 03/02/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.46 rs: Final st: NotStopd
t0: [12:00:00 03/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:00:00 03/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10.3448 u1: ml/cmH st: NotStopd t0: [12:00:00 03/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 03/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 03/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [12:00:00 03/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [12:00:00 03/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.6 st: NotStopd t0: [12:00:00 03/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 03/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 03/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 03/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 03/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [12:00:00 03/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 03/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 03/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [12:00:00 03/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13.8 u1: L/min st: NotStopd t0: [12:00:00 03/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 03/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 03/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 34 u1: cmH2O st: NotStopd t0: [12:00:00 03/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [12:00:00 03/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 24 u1: BPM st: NotStopd t0: [12:00:00 03/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [12:00:00 03/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:00:00 03/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:00:00 03/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [12:00:00 03/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:00:00 03/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 03/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:00:00 03/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:00:00 03/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:00:00 03/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:00:00 03/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 03/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [12:07:00 03/02/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: no data rs: Final st: NotStopd t0: [12:07:00 03/02/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: no data rs: Final st: NotStopd t0: [12:07:00 03/02/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: no data rs: Final st: NotStopd t0: [12:07:00 03/02/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 12 u1: mmHg rs: Final st: NotStopd t0: [12:07:00 03/02/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 u1: mmHg rs: Final st: NotStopd t0: [12:07:00 03/02/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: no data rs: Final st: NotStopd t0: [12:12:00 03/02/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: RRT v1: 32 rs: Final st: NotStopd t0: [12:12:00 03/02/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: RRT v1: 44 u1: mmHg rs: Manual st: NotStopd
t0: [13:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 03/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [13:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 03/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [13:00:00 03/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [13:00:00 03/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [13:00:00 03/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [13:00:00 03/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [13:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [13:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 03/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 03/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [13:00:00 03/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 03/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [13:00:00 03/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [13:00:00 03/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [13:00:00 03/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [13:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [13:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 107.667 u1: mmHg st: NotStopd t0: [13:00:00 03/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [13:00:00 03/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 03/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [13:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 03/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [13:00:00 03/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [13:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [13:00:00 03/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [13:00:00 03/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 03/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [13:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 03/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [13:00:00 03/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [13:00:00 03/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [13:00:00 03/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [13:00:00 03/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [13:00:00 03/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [13:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [14:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [14:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [14:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [14:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [14:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [14:00:00 03/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [15:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [15:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [15:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [15:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 42 u1: BPM st: NotStopd t0: [15:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 03/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 23 st: NotStopd t0: [16:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 03/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 03/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 03/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 03/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [16:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 03/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 03/02/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [16:00:00 03/02/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [16:00:00 03/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 03/02/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [16:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [16:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.6667 u1: mmHg st: NotStopd t0: [16:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 03/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [16:00:00 03/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 03/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 03/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 03/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 03/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [16:00:00 03/02/2016] id: Trach Size el: 0 cu: MICU cg: RN v1: #8 st: NotStopd t0: [16:00:00 03/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Portex st: NotStopd t0: [16:00:00 03/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 03/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [16:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [16:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [17:00:00 03/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [17:00:00 03/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 11.5385 u1: ml/cmH st: NotStopd t0: [17:00:00 03/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [17:00:00 03/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 03/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [17:00:00 03/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [17:00:00 03/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.6 st: NotStopd t0: [17:00:00 03/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [17:00:00 03/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [17:00:00 03/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 03/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 03/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [17:00:00 03/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 03/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:00:00 03/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [17:00:00 03/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [17:00:00 03/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 03/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 03/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [17:00:00 03/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [17:00:00 03/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [17:00:00 03/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [17:00:00 03/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [17:00:00 03/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [17:00:00 03/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [17:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [17:00:00 03/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [17:00:00 03/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [17:00:00 03/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [17:00:00 03/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [17:00:00 03/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [17:00:00 03/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [17:00:00 03/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [17:00:00 03/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [17:00:00 03/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [17:00:00 03/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 03/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [16:00:00 03/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 03/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 03/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 03/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 03/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 03/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 03/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 03/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 03/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 03/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [16:00:00 03/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 03/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 03/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 03/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 03/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 03/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 03/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [16:00:00 03/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [16:00:00 03/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 03/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 03/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [16:00:00 03/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Logroll st: NotStopd t0: [16:00:00 03/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 03/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:30:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:30:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:30:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:30:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:30:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:30:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [17:30:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:30:00 03/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [17:30:00 03/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [17:30:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [17:30:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102.333 u1: mmHg st: NotStopd t0: [17:30:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:30:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [17:30:00 03/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:30:00 03/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [17:30:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:30:00 03/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [17:30:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:30:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 15 vu: ml t0: [17:30:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 112.5 vu: ml
t0: [18:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 03/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 200 vu: ml t0: [18:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 37.5 vu: ml
t0: [23:00:00 03/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 775 ap: none
t0: [18:00:00 03/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 129 rs: Manual st: NotStopd
t0: [19:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 03/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [19:00:00 03/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 03/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [19:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [19:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 03/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [19:00:00 03/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [19:00:00 03/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:00:00 03/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [19:00:00 03/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [19:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [19:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.667 u1: mmHg st: NotStopd t0: [19:00:00 03/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [19:00:00 03/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [19:00:00 03/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [19:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 03/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [19:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [19:00:00 03/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [19:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 03/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [19:00:00 03/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.8889 u1: Deg. C st: NotStopd t0: [19:00:00 03/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.2 u1: Deg. F st: NotStopd t0: [19:00:00 03/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [19:00:00 03/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [19:00:00 03/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [19:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [19:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [19:00:00 04/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 20 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [20:00:00 03/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: CRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 03/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 14.2857 u1: ml/cmH st: NotStopd t0: [20:00:00 03/02/2016] id: Cuff Leak el: 0 cu: MICU cg: CRT v1: No st: NotStopd t0: [20:00:00 03/02/2016] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 03/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 03/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 30 u1: BPM st: NotStopd t0: [20:00:00 03/02/2016] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:3.6 st: NotStopd t0: [20:00:00 03/02/2016] id: Airway Size el: 0 cu: MICU cg: CRT v1: 8.0 mm st: NotStopd t0: [20:00:00 03/02/2016] id: Airway Type el: 0 cu: MICU cg: CRT v1: Tracheostomy st: NotStopd t0: [20:00:00 03/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35.1 u1: Deg. C st: NotStopd t0: [20:00:00 03/02/2016] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 03/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [20:00:00 03/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 03/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 03/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 03/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 10.8 u1: L/min st: NotStopd t0: [20:00:00 03/02/2016] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 03/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [20:00:00 03/02/2016] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [20:00:00 03/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 26 u1: cmH2O st: NotStopd t0: [20:00:00 03/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 24 u1: cmH2O st: NotStopd t0: [20:00:00 03/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 6 u1: BPM st: NotStopd t0: [20:00:00 03/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 26 u1: BPM st: NotStopd t0: [20:00:00 03/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 03/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: CRT v1: 100 u1: % st: NotStopd t0: [20:00:00 03/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 326 u1: ml/B st: NotStopd t0: [20:00:00 03/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 03/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: CRT v1: Yes v2: No st: NotStopd t0: [20:00:00 03/02/2016] id: Trach Size el: 0 cu: MICU cg: CRT v1: #8 st: NotStopd t0: [20:00:00 03/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: CRT v1: Inflated st: NotStopd t0: [20:00:00 03/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: CRT v1: Portex st: NotStopd t0: [20:00:00 03/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [20:00:00 03/02/2016] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [20:00:00 03/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [20:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 03/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 03/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 03/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 03/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 03/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 03/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 03/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 03/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [20:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 03/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 03/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 03/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 03/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 03/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 03/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 03/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [20:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [20:00:00 03/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 03/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 03/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [20:00:00 03/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 03/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 03/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 03/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 03/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 03/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 03/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 03/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 03/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 03/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 03/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [21:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [21:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [21:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.3333 u1: mmHg st: NotStopd t0: [21:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [21:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [21:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [20:00:00 03/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 03/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [22:00:00 03/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [22:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 03/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [22:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [22:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [22:00:00 03/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [22:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [22:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [21:00:00 04/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 22 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [23:00:00 03/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 03/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 03/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 03/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 03/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 03/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [23:00:00 03/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 03/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [23:00:00 03/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [23:00:00 03/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 03/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [23:00:00 03/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 03/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 03/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 03/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [00:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 04/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 04/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [00:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [00:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [00:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 43 u1: BPM st: NotStopd t0: [00:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 04/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 04/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38 u1: Deg. C st: NotStopd t0: [00:00:00 04/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.4 u1: Deg. F st: NotStopd t0: [00:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [00:00:00 04/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: CRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 04/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 13.6364 u1: ml/cmH st: NotStopd t0: [00:00:00 04/02/2016] id: Cuff Leak el: 0 cu: MICU cg: CRT v1: No st: NotStopd t0: [00:00:00 04/02/2016] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 04/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 04/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 04/02/2016] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:3.6 st: NotStopd t0: [00:00:00 04/02/2016] id: Airway Size el: 0 cu: MICU cg: CRT v1: 8.0 mm st: NotStopd t0: [00:00:00 04/02/2016] id: Airway Type el: 0 cu: MICU cg: CRT v1: Tracheostomy st: NotStopd t0: [00:00:00 04/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 04/02/2016] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 04/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [00:00:00 04/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 04/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 04/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 04/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 11.1 u1: L/min st: NotStopd t0: [00:00:00 04/02/2016] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 04/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [00:00:00 04/02/2016] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [00:00:00 04/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 27 u1: cmH2O st: NotStopd t0: [00:00:00 04/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 24 u1: cmH2O st: NotStopd t0: [00:00:00 04/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 18 u1: BPM st: NotStopd t0: [00:00:00 04/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 38 u1: BPM st: NotStopd t0: [00:00:00 04/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 04/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 04/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 04/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 04/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: CRT v1: Yes v2: No st: NotStopd t0: [00:00:00 04/02/2016] id: Trach Size el: 0 cu: MICU cg: CRT v1: #8 st: NotStopd t0: [00:00:00 04/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: CRT v1: Inflated st: NotStopd t0: [00:00:00 04/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: CRT v1: Portex st: NotStopd t0: [00:00:00 04/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [00:00:00 04/02/2016] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [00:00:00 04/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [01:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [00:00:00 04/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 04/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 04/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 04/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 04/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 04/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 04/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 04/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 04/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 04/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 04/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 04/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 04/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 04/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 04/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 04/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 04/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 04/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [00:00:00 04/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 04/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 04/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 04/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 04/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 04/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 04/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 04/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 04/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 04/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 04/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 04/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [00:00:00 04/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 04/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 04/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 04/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 04/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 04/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thin st: NotStopd t0: [00:00:00 04/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [00:00:00 04/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 04/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 04/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 04/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [00:00:00 04/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 04/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 04/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 04/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 04/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 04/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 04/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 120 rs: Manual st: NotStopd t0: [00:00:00 04/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [01:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [01:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [01:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.3333 u1: mmHg st: NotStopd t0: [01:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [01:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [02:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [02:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [02:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [02:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [03:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [03:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [03:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [03:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [03:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 04/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 04/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 85 cv: 85 ap: none t0: [23:00:00 04/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 10 cv: 550 ap: none t0: [23:00:00 04/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 85 cv: 2150 ap: none t0: [23:00:00 04/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1200 ap: none t0: [23:00:00 04/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 3265 ap: none t0: [23:00:00 04/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 85 cv: -1315 ap: none t0: [23:00:00 04/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 3465 ap: none t0: [23:00:00 04/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 85 cv: 8622.54 ap: carryForward
t0: [04:00:00 04/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: CRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 04/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: CRT v1: 12.5 u1: ml/cmH st: NotStopd t0: [04:00:00 04/02/2016] id: RSBI (<100) el: 0 cu: MICU cg: CRT v1: 200 u1: units st: NotStopd t0: [04:00:00 04/02/2016] id: Cuff Leak el: 0 cu: MICU cg: CRT v1: No st: NotStopd t0: [04:00:00 04/02/2016] id: FiO2 Set el: 0 cu: MICU cg: CRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 04/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: CRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 04/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: CRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 04/02/2016] id: I:E Ratio el: 0 cu: MICU cg: CRT v1: 1:2.6 st: NotStopd t0: [04:00:00 04/02/2016] id: Airway Size el: 0 cu: MICU cg: CRT v1: 8.0 mm st: NotStopd t0: [04:00:00 04/02/2016] id: Airway Type el: 0 cu: MICU cg: CRT v1: Tracheostomy st: NotStopd t0: [04:00:00 04/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: CRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 04/02/2016] id: Intubation Date el: 0 cu: MICU cg: CRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 04/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: CRT v1: 7 st: NotStopd t0: [04:00:00 04/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 04/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: CRT v1: 16 u1: cmH2O st: NotStopd t0: [04:00:00 04/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: CRT v1: 11.4 u1: L/min st: NotStopd t0: [04:00:00 04/02/2016] id: PEEP Set el: 0 cu: MICU cg: CRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 04/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: CRT v1: 20 st: NotStopd t0: [04:00:00 04/02/2016] id: Peak Flow el: 0 cu: MICU cg: CRT u1: L/m st: NotStopd t0: [04:00:00 04/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: CRT v1: 29 u1: cmH2O st: NotStopd t0: [04:00:00 04/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: CRT v1: 29 u1: cmH2O st: NotStopd t0: [04:00:00 04/02/2016] id: RSBI (<200) el: 0 cu: MICU cg: CRT v1: 200 u1: units st: NotStopd t0: [04:00:00 04/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: CRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 04/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: CRT v1: 40 u1: BPM st: NotStopd t0: [04:00:00 04/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: CRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 04/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: CRT v1: 13 u1: cmH2O st: NotStopd t0: [04:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: CRT v1: 100 u1: % st: NotStopd t0: [04:00:00 04/02/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: CRT v1: 40 u1: BPM st: NotStopd t0: [04:00:00 04/02/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: CRT v1: 0.2 u1: L st: NotStopd t0: [04:00:00 04/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: CRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 04/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: CRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 04/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: CRT v1: Yes v2: No st: NotStopd t0: [04:00:00 04/02/2016] id: Trach Size el: 0 cu: MICU cg: CRT v1: #8 st: NotStopd t0: [04:00:00 04/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: CRT v1: Inflated st: NotStopd t0: [04:00:00 04/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: CRT v1: Portex st: NotStopd t0: [04:00:00 04/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: CRT v1: Assist Control st: NotStopd t0: [04:00:00 04/02/2016] id: Ventilator Type el: 0 cu: MICU cg: CRT v1: Drager st: NotStopd t0: [04:00:00 04/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: CRT v1: RAMP st: NotStopd
t0: [02:00:00 04/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 04/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [04:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [04:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [04:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [04:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [04:00:00 04/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: CRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 04/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 04/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [04:00:00 04/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [05:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [05:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [05:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [05:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [05:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [04:36:00 04/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 15.5 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 13 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.1 u1: mg/dl rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 102 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.3 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.3 u1: mEq/L rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 140 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 15.5 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 13 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.1 u1: mg/dl rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 102 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 103 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 21.6 u1: % rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 6.6 u1: gm/dl rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.3 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.3 u1: mEq/L rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 526 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.33 u1: /mic l rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 140 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 15.5 rs: Final st: NotStopd
t0: [04:36:00 04/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 14 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [04:36:00 04/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14 rs: Final st: NotStopd
t0: [02:00:00 04/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [02:00:00 04/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 04/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 04/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 04/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 04/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 04/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 04/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 04/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 04/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 04/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 04/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 04/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 04/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 04/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 04/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 04/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 04/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 04/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 04/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 04/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 04/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 04/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 04/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 04/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 04/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 04/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 04/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 04/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 04/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 04/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 04/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 04/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [04:00:00 04/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 04/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 04/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 04/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 04/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 04/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 04/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 04/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 04/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 04/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 04/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 04/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [04:00:00 04/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 04/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 04/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 04/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 04/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 04/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done t0: [04:00:00 04/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 04/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [06:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [06:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [06:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [06:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [06:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [06:00:00 04/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 127 rs: Manual st: NotStopd
t0: [08:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 04/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 04/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [08:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [08:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [08:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [08:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 04/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 04/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [08:00:00 04/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [08:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 04/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 250 vu: ml t0: [08:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [08:00:00 04/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:00:00 04/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.5 u1: ml/cmH st: NotStopd t0: [08:00:00 04/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 04/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 04/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:00:00 04/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 04/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.6 st: NotStopd t0: [08:00:00 04/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 04/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 04/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 04/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 04/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [08:00:00 04/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 04/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 04/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [08:00:00 04/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.32 u1: L/min st: NotStopd t0: [08:00:00 04/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 04/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 04/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [08:00:00 04/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [08:00:00 04/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [08:00:00 04/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [08:00:00 04/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 04/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 04/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [08:00:00 04/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 04/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 270 u1: ml/B st: NotStopd t0: [08:00:00 04/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:00:00 04/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 04/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 04/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 04/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 04/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 04/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 04/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 04/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 04/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 04/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 04/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 04/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 04/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 04/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 04/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 04/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 04/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 04/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 04/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 04/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 04/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 04/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 04/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 04/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 04/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 04/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 04/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 04/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 04/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 04/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 04/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 04/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 04/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 04/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 04/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 04/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 04/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 04/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 04/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 04/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 04/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 04/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 04/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 04/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 04/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 04/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 04/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 04/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 04/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 04/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 04/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [08:00:00 04/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 04/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 04/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 04/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 04/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 04/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 04/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 04/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 04/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 04/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 04/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 04/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [08:00:00 04/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [08:30:00 04/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [08:30:00 04/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:30:00 04/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:30:00 04/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:30:00 04/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:30:00 04/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [08:30:00 04/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd
t0: [08:00:00 04/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 04/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 04/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 04/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd
t0: [09:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [09:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [09:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.6667 u1: mmHg st: NotStopd t0: [09:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [09:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [09:00:00 05/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Metolazone v1: 2.5 u1: mg
t0: [10:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [10:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [10:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [10:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [10:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:30:00 04/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:30:00 04/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:30:00 04/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:30:00 04/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:30:00 04/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [10:30:00 04/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [10:30:00 04/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [10:30:00 04/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [10:30:00 04/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd
t0: [10:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml st: Stopped
t0: [11:00:00 04/02/2016] id: Radiologic Study el: 0 cu: MICU cg: RN v1: Chest Xray st: NotStopd
t0: [11:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [11:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 93 u2: mmHg st: NotStopd t0: [11:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 113 u1: mmHg st: NotStopd t0: [11:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [11:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:30:00 04/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [11:30:00 04/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10 u1: ml/cmH st: NotStopd t0: [11:30:00 04/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [11:30:00 04/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [11:30:00 04/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [11:30:00 04/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [11:30:00 04/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.6 st: NotStopd t0: [11:30:00 04/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [11:30:00 04/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:30:00 04/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:30:00 04/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:30:00 04/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [11:30:00 04/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [11:30:00 04/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.78 u1: L/min st: NotStopd t0: [11:30:00 04/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:30:00 04/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:30:00 04/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [11:30:00 04/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd t0: [11:30:00 04/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 12 u1: BPM st: NotStopd t0: [11:30:00 04/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [11:30:00 04/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [11:30:00 04/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [11:30:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [11:30:00 04/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 298 u1: ml/B st: NotStopd t0: [11:30:00 04/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [11:30:00 04/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [11:30:00 04/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [11:30:00 04/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [11:30:00 04/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [11:30:00 04/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [11:30:00 04/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [11:30:00 04/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 04/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
tf: [11:00:00 05/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 12 dn: 1 m1: Bumetanide v1: 2 u1: mg
t0: [11:30:00 04/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [12:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 04/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [12:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [12:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.3333 u1: mmHg st: NotStopd t0: [12:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [12:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:30:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:30:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:30:00 04/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:30:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:30:00 04/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:30:00 04/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:30:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 04/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:30:00 04/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:30:00 04/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:30:00 04/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:30:00 04/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [12:30:00 04/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:30:00 04/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:30:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [12:30:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:30:00 04/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:30:00 04/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:30:00 04/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:30:00 04/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:30:00 04/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:30:00 04/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:30:00 04/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:30:00 04/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [12:30:00 04/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:30:00 04/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:30:00 04/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:30:00 04/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Arouse to Voice st: NotStopd t0: [12:30:00 04/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:30:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [12:30:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [12:30:00 04/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:30:00 04/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:30:00 04/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:30:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:30:00 04/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:30:00 04/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:30:00 04/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:30:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [12:30:00 04/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:30:00 04/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:30:00 04/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:30:00 04/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:30:00 04/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:30:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:30:00 04/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:30:00 04/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:30:00 04/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:30:00 04/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:30:00 04/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:30:00 04/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:30:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:30:00 04/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:30:00 04/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 89 rs: Manual st: NotStopd t0: [12:30:00 04/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:30:00 04/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [12:30:00 04/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [12:30:00 04/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [12:30:00 04/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [12:30:00 04/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [12:30:00 04/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [12:30:00 04/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [13:00:00 04/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 04/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 04/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 04/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 04/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [13:00:00 04/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:00:00 04/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [13:00:00 04/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [13:00:00 04/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd
t0: [11:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml st: Stopped
t0: [13:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [13:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [13:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [13:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [13:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 04/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 200 ap: none
t0: [14:30:00 04/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [14:30:00 04/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10 u1: ml/cmH st: NotStopd t0: [14:30:00 04/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [14:30:00 04/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [14:30:00 04/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [14:30:00 04/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [14:30:00 04/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.6 st: NotStopd t0: [14:30:00 04/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [14:30:00 04/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [14:30:00 04/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [14:30:00 04/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [14:30:00 04/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [14:30:00 04/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [14:30:00 04/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [14:30:00 04/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [14:30:00 04/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [14:30:00 04/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [14:30:00 04/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [14:30:00 04/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [14:30:00 04/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [14:30:00 04/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [14:30:00 04/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [14:30:00 04/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [14:30:00 04/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [14:30:00 04/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [14:30:00 04/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [14:30:00 04/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [14:30:00 04/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [14:30:00 04/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [14:30:00 04/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [14:30:00 04/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [14:30:00 04/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [14:30:00 04/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [13:30:00 04/02/2016] id: Procedures el: 0 cu: MICU cg: RN v1: Fluoroscopy st: NotStopd t0: [15:00:00 04/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [15:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 04/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 04/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [15:00:00 04/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [15:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 04/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [15:00:00 04/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [15:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 04/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [15:00:00 04/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 04/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [15:00:00 04/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [15:00:00 04/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [15:00:00 04/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 04/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [15:00:00 04/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [15:00:00 04/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [15:00:00 04/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [15:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 04/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 04/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [15:00:00 04/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [15:00:00 04/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [15:00:00 04/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [15:00:00 04/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 04/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 04/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [15:00:00 04/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [15:00:00 04/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [15:00:00 04/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [15:00:00 04/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [15:00:00 04/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 04/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [15:00:00 04/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [15:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [15:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105.667 u1: mmHg st: NotStopd t0: [15:00:00 04/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 04/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [15:00:00 04/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [15:00:00 04/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 04/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [15:00:00 04/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [15:00:00 04/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 04/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [15:00:00 04/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [15:00:00 04/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [15:00:00 04/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [15:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [15:00:00 04/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [15:00:00 04/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 04/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [15:00:00 04/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 04/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [15:00:00 04/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [15:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 04/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [15:00:00 04/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [15:00:00 04/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [15:00:00 04/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [15:00:00 04/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [15:00:00 04/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [15:00:00 04/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [15:00:00 04/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [15:00:00 04/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [15:00:00 04/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [15:00:00 04/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [15:00:00 04/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [15:00:00 04/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 04/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [15:00:00 04/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [15:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vu: ml st: Restart t0: [15:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vu: ml st: Restart
t0: [16:00:00 04/02/2016] id: TCPCV I:E Ratio el: 0 cu: MICU cg: -1 st: D/C'd t0: [16:00:00 04/02/2016] id: TCPCV Insp. Pressure el: 0 cu: MICU cg: -1 st: D/C'd t0: [16:00:00 04/02/2016] id: TCPCV Insp. Time el: 0 cu: MICU cg: -1 st: D/C'd t0: [16:00:00 04/02/2016] id: TCPCV-MAP el: 0 cu: MICU cg: -1 st: D/C'd
t0: [16:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [16:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [16:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [16:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [16:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 04/02/2016] tf: [17:00:00 05/02/2016] dt: 1500 id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [16:40:00 04/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:40:00 04/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 13.6364 u1: ml/cmH st: NotStopd t0: [16:40:00 04/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:40:00 04/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:40:00 04/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [16:40:00 04/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [16:40:00 04/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.6 st: NotStopd t0: [16:40:00 04/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:40:00 04/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:40:00 04/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:40:00 04/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:40:00 04/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [16:40:00 04/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:40:00 04/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:40:00 04/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [16:40:00 04/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [16:40:00 04/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:40:00 04/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:40:00 04/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [16:40:00 04/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [16:40:00 04/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd t0: [16:40:00 04/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [16:40:00 04/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [16:40:00 04/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [16:40:00 04/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:40:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [16:40:00 04/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [16:40:00 04/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [16:40:00 04/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [16:40:00 04/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [16:40:00 04/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:40:00 04/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:40:00 04/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:40:00 04/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:40:00 04/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [16:40:00 04/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [11:30:00 04/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:30:00 04/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd
t0: [17:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [17:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [17:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [17:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [17:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
id: Po Intake el: 1 cu: MICU cg: RN io: Po Intake PO/Gastric du: ml rt: Oral
t0: [18:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [18:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [18:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86.3333 u1: mmHg st: NotStopd t0: [18:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [18:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 04/02/2016] tf: [17:24:00 26/02/2016] dt: 31644 id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 60 vu: ml
t0: [23:00:00 04/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 400 ap: none
t0: [18:00:00 04/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 129 rs: Manual st: NotStopd
t0: [19:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 87 u1: BPM st: NotStopd t0: [19:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [19:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [19:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [19:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 04/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 04/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 04/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 04/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 04/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 04/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 04/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 04/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 04/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 04/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 04/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 04/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 04/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 04/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 04/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 04/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 04/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [20:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 04/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 04/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 04/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 04/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 04/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 04/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 04/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 04/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 04/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 04/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 04/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 04/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 04/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 04/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 04/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [20:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.6667 u1: mmHg st: NotStopd t0: [20:00:00 04/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 04/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 04/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 04/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 04/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 04/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 04/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 04/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 04/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [20:00:00 04/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 04/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 04/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [20:00:00 04/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 04/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 04/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 04/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 04/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 04/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 04/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [20:00:00 04/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [20:00:00 04/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 04/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [20:00:00 04/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 04/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 04/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 04/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.4444 u1: Deg. C st: NotStopd t0: [20:00:00 04/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.4 u1: Deg. F st: NotStopd t0: [20:00:00 04/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 04/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 04/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 04/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 04/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 04/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 04/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [20:00:00 04/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [19:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 30 vu: ml t0: [20:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [20:00:00 04/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 04/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 11.1111 u1: ml/cmH st: NotStopd t0: [20:00:00 04/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 04/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 04/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 04/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [20:00:00 04/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 04/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 04/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 04/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 04/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [20:00:00 04/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 04/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 04/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [20:00:00 04/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [20:00:00 04/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 04/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 04/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [20:00:00 04/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [20:00:00 04/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [20:00:00 04/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 04/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 04/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 285 u1: ml/B st: NotStopd t0: [20:00:00 04/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 04/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 04/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 04/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 04/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 04/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 04/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 04/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 04/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Fam Talked to MD st: NotStopd t0: [21:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [21:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [21:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [21:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [21:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 04/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [21:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [22:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 04/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 04/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [22:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 04/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 04/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [22:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [22:00:00 04/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 04/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 04/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [22:00:00 04/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 04/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [22:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [22:00:00 04/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 04/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [22:00:00 04/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [22:00:00 04/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [23:00:00 04/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 04/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 04/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [23:00:00 04/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 04/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 04/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 04/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [23:00:00 04/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 04/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [23:00:00 04/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [23:00:00 04/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 04/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [23:00:00 04/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 04/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 84 u1: BPM st: NotStopd t0: [00:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [00:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 82.3333 u1: mmHg st: NotStopd t0: [00:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [00:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 04/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [00:00:00 05/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi v2: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 05/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 05/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 05/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 05/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 05/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 05/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 05/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 05/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 05/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 05/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 05/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 05/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 05/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 05/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 05/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 05/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 05/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 05/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 05/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 05/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 05/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 05/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 05/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 05/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 05/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 05/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 05/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 05/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 05/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 05/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 05/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 05/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 05/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 05/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 05/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 05/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 05/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 05/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.1111 u1: Deg. C st: NotStopd t0: [00:00:00 05/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.6 u1: Deg. F st: NotStopd t0: [00:00:00 05/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 05/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 05/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 05/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [00:00:00 05/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [00:00:00 05/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 05/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 05/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 05/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [01:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [01:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [01:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [01:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [01:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 05/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: RN ai: 274 vo: 60 vu: ml t0: [01:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [23:00:00 05/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 420 ap: none
t0: [01:00:00 05/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [01:00:00 05/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12 u1: ml/cmH st: NotStopd t0: [01:00:00 05/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [01:00:00 05/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [01:00:00 05/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [01:00:00 05/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [01:00:00 05/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [01:00:00 05/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [01:00:00 05/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [01:00:00 05/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 05/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6 st: NotStopd t0: [01:00:00 05/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [01:00:00 05/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [01:00:00 05/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [01:00:00 05/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.7 u1: L/min st: NotStopd t0: [01:00:00 05/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [01:00:00 05/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 05/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [01:00:00 05/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [01:00:00 05/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [01:00:00 05/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [01:00:00 05/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [01:00:00 05/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [01:00:00 05/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [01:00:00 05/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [01:00:00 05/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [01:00:00 05/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [01:00:00 05/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [01:00:00 05/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [01:00:00 05/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [01:00:00 05/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [02:00:00 05/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [02:00:00 05/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd
t0: [00:00:00 05/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 141 rs: Manual st: NotStopd t0: [02:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [02:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [02:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.3333 u1: mmHg st: NotStopd t0: [02:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [02:00:00 05/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 05/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [23:00:00 05/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 05/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 75 cv: 75 ap: none t0: [23:00:00 05/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 730 ap: none t0: [23:00:00 05/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 75 cv: 3325 ap: none t0: [23:00:00 05/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 2755 ap: none t0: [23:00:00 05/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 75 cv: 570 ap: none t0: [23:00:00 05/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 2755 ap: none t0: [23:00:00 05/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 75 cv: 9192.54 ap: carryForward
t0: [03:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [03:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [03:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [03:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 12 u1: BPM st: NotStopd t0: [03:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [03:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 05/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [02:00:00 05/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [02:00:00 05/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [02:00:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [02:00:00 05/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [02:00:00 05/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [02:00:00 05/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [02:00:00 05/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [02:00:00 05/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd
t0: [04:00:00 05/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 05/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 11.1111 u1: ml/cmH st: NotStopd t0: [04:00:00 05/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 05/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 05/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 05/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 05/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 05/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 05/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 05/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 05/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 05/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [04:00:00 05/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7 u1: L/min st: NotStopd t0: [04:00:00 05/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 05/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 05/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [04:00:00 05/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [04:00:00 05/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [04:00:00 05/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 05/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [04:00:00 05/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 05/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 05/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 05/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 05/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 05/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 05/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:00:00 05/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 05/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 05/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 05/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 05/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 05/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 05/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 05/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 05/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 05/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [04:00:00 05/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 05/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 05/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 05/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 05/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 05/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 05/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 05/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [04:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 05/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 05/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 05/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 05/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 05/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 05/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 05/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 05/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 05/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 05/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 05/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 05/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 05/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [04:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.6667 u1: mmHg st: NotStopd t0: [04:00:00 05/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 05/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 05/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 05/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 05/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 05/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 05/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [04:00:00 05/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 05/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 05/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [04:00:00 05/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 05/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 05/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 05/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 05/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 05/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 05/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 05/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 05/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 05/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [04:00:00 05/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [04:00:00 05/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 05/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 05/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 05/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 05/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 05/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 05/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 05/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [19:00:00 04/02/2016] tf: [10:00:00 16/02/2016] dt: 16740 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [20:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [21:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [22:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [23:00:00 04/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [00:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [01:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [02:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [03:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [04:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [03:40:00 05/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 12.6 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 12.6 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 20.5 u1: % rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 6.3 u1: gm/dl rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 565 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.23 u1: /mic l rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 12.6 rs: Final st: NotStopd
t0: [03:40:00 05/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 14.1 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14.1 rs: Final st: NotStopd
t0: [03:40:00 05/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 89 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 u1: mEq/L rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 140 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 7.7 u1: mg/dl rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 89 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 u1: mEq/L rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 rs: Final st: NotStopd t0: [03:40:00 05/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 140 rs: Final st: NotStopd
t0: [05:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [05:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [05:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78.6667 u1: mmHg st: NotStopd t0: [05:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 10 u1: BPM st: NotStopd t0: [05:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [05:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [04:00:00 05/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 05/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [06:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 05/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [06:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [06:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 05/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 05/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [06:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [06:00:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 05/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 05/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 05/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [06:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [06:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 05/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [06:00:00 05/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [06:00:00 05/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [06:00:00 05/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [06:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [05:00:00 06/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 6 dn: 1 m1: Calcium Gluconate v1: 2 u1: gm tf: [05:00:00 06/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 6 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [07:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [07:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [07:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.6667 u1: mmHg st: NotStopd t0: [07:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [07:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 05/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [07:00:00 05/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [07:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [07:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [07:00:00 06/02/2016] pt: Unit Dose rt: NG fr: ONCE fs: 8 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq tf: [07:00:00 06/02/2016] pt: Unit Dose rt: PO fr: ONCE fs: 8 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq
t0: [08:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [08:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [08:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.6667 u1: mmHg st: NotStopd t0: [08:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [08:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [08:00:00 05/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 05/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 05/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 05/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 05/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 05/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 05/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 05/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 05/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 05/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 05/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 05/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 05/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 05/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 05/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 05/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [08:00:00 05/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 05/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 05/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 05/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 05/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 05/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 05/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [08:00:00 05/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 05/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 05/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 05/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 05/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 05/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 05/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 05/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 05/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 05/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 05/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 05/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 05/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 05/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 05/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [08:00:00 05/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 05/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 05/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 05/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 05/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 05/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 05/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 05/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 05/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 05/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 05/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 05/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 05/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 05/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 05/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 05/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [08:00:00 05/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 05/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 05/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 05/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 05/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 05/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 05/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 05/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [08:00:00 05/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:00:00 05/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 05/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd
t0: [08:37:00 05/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:37:00 05/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10 u1: ml/cmH st: NotStopd t0: [08:37:00 05/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:37:00 05/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:37:00 05/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:37:00 05/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:37:00 05/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.6 st: NotStopd t0: [08:37:00 05/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:37:00 05/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:37:00 05/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.3 u1: Deg. C st: NotStopd t0: [08:37:00 05/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:37:00 05/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [08:37:00 05/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:37:00 05/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:37:00 05/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [08:37:00 05/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.3 u1: L/min st: NotStopd t0: [08:37:00 05/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:37:00 05/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:37:00 05/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [08:37:00 05/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:37:00 05/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT u1: cmH2O st: NotStopd t0: [08:37:00 05/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [08:37:00 05/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [08:37:00 05/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:37:00 05/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:37:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [08:37:00 05/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [08:37:00 05/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:37:00 05/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:37:00 05/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:37:00 05/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:37:00 05/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:37:00 05/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:37:00 05/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:37:00 05/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:37:00 05/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
tf: [08:00:00 06/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 9 dn: 1 m1: Bumetanide v1: 2 u1: mg tf: [08:00:00 06/02/2016] pt: Unit Dose rt: NG fr: ONCE fs: 9 dn: 1 m1: Metolazone v1: 2.5 u1: mg
t0: [09:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [09:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 05/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [09:00:00 05/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [09:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [09:00:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 05/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [09:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 05/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [09:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [09:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [09:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [10:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [10:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [10:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [10:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [10:00:00 05/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [10:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [12:00:00 07/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Lisinopril v1: 5 u1: mg tf: [21:00:00 26/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Sertraline HCl v1: 50 u1: mg
t0: [10:31:00 05/02/2016] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [11:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [11:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [11:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [11:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [11:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 05/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [11:00:00 05/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.2778 u1: Deg. C st: NotStopd t0: [11:00:00 05/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.9 u1: Deg. F st: NotStopd t0: [11:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [11:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
tf: [10:00:00 06/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 11 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm tf: [10:00:00 06/02/2016] pt: Unit Dose rt: NG fr: ONCE fs: 11 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq tf: [10:00:00 06/02/2016] pt: Unit Dose rt: PO fr: ONCE fs: 11 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq
id: Packed RBC's el: 1 cu: MICU cg: RN io: Packed RBC's IV Infusions du: ml rt: Intravenous Push
t0: [12:00:00 05/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 141 rs: Manual st: NotStopd
t0: [11:30:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:30:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:30:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [11:30:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:30:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [11:30:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.3333 u1: mmHg st: NotStopd t0: [11:30:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:30:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [11:30:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:30:00 05/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [11:30:00 05/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 38.0556 u1: Deg. C st: NotStopd t0: [11:30:00 05/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.5 u1: Deg. F st: NotStopd t0: [11:30:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 05/02/2016] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: -1 vu: ml nb: 1
t0: [11:30:00 05/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [11:30:00 05/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [11:30:00 05/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [11:30:00 05/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [11:30:00 05/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [11:30:00 05/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [11:30:00 05/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:30:00 05/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [11:30:00 05/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [11:30:00 05/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [11:30:00 05/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [11:30:00 05/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [11:30:00 05/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [11:30:00 05/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [11:30:00 05/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [11:30:00 05/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [11:30:00 05/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [11:30:00 05/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [11:30:00 05/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [11:30:00 05/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [11:30:00 05/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [11:30:00 05/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [11:30:00 05/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [11:30:00 05/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [11:30:00 05/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [11:30:00 05/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [11:30:00 05/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [11:30:00 05/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [11:30:00 05/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [11:30:00 05/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [11:30:00 05/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:30:00 05/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [11:30:00 05/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [12:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [12:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [12:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.3333 u1: mmHg st: NotStopd t0: [12:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [12:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [21:00:00 26/02/2016] pt: Unit Dose rt: PO fr: Q4-6H:PRN m1: Acetaminophen (Liquid) v1: 650 u1: mg
t0: [12:11:00 05/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:11:00 05/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10 u1: ml/cmH st: NotStopd t0: [12:11:00 05/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:11:00 05/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:11:00 05/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [12:11:00 05/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [12:11:00 05/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.6 st: NotStopd t0: [12:11:00 05/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:11:00 05/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:11:00 05/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:11:00 05/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:11:00 05/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [12:11:00 05/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Albuterol st: NotStopd t0: [12:11:00 05/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [12:11:00 05/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:11:00 05/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.5 u1: L/min st: NotStopd t0: [12:11:00 05/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:11:00 05/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:11:00 05/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [12:11:00 05/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [12:11:00 05/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [12:11:00 05/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:11:00 05/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:11:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:11:00 05/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:11:00 05/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:11:00 05/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:11:00 05/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:11:00 05/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:11:00 05/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:11:00 05/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:11:00 05/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [13:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [13:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [13:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.3333 u1: mmHg st: NotStopd t0: [13:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [13:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [13:00:00 05/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 05/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 05/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [13:00:00 05/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 05/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [13:00:00 05/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:00:00 05/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [13:00:00 05/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 05/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [13:00:00 05/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd
t0: [12:00:00 05/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 05/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.9444 u1: Deg. C st: NotStopd t0: [12:00:00 05/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100.3 u1: Deg. F st: NotStopd t0: [14:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [14:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [14:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.6667 u1: mmHg st: NotStopd t0: [14:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [14:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 05/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [14:00:00 05/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [14:00:00 05/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [14:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [15:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [15:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [15:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [15:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [15:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [16:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 05/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 05/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 05/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 05/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [16:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [16:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.3333 u1: mmHg st: NotStopd t0: [16:00:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 05/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [16:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [16:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 97 u1: % st: NotStopd t0: [16:00:00 05/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 05/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [16:00:00 05/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [16:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 05/02/2016] tf: [14:00:00 09/02/2016] dt: 5700 id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 375 vu: ml t0: [16:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [16:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [23:00:00 05/02/2016] dt: 24 id: Blood Products Total el: 2 cu: MICU cg: RN cv: 375 ap: none
t0: [14:15:00 05/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 rs: Final st: NotStopd t0: [14:15:00 05/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [14:15:00 05/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 rs: Final st: NotStopd t0: [14:15:00 05/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd
t0: [17:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [17:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [17:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.3333 u1: mmHg st: NotStopd t0: [17:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [17:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 05/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: RN ai: 107 vo: 10 vu: ml st: Stopped t0: [17:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [16:00:00 05/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 05/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 05/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 05/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 05/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 05/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 05/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 05/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 05/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 05/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 05/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 05/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 05/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 05/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 05/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 05/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 05/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 05/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [16:00:00 05/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 05/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 05/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 05/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 05/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 05/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 05/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [16:00:00 05/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 05/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 05/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 05/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 05/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 05/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 05/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 05/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [16:00:00 05/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 05/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 05/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 05/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 05/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 05/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Cooperative st: NotStopd t0: [16:00:00 05/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 05/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 05/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 05/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 05/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 05/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 05/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [16:00:00 05/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:30:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [17:30:00 05/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [17:30:00 05/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:30:00 05/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [17:30:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:30:00 05/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [17:30:00 05/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:30:00 05/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [17:30:00 05/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [17:30:00 05/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd
t0: [17:30:00 05/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:30:00 05/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:30:00 05/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:30:00 05/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [18:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [18:10:00 05/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [18:10:00 05/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 11.1111 u1: ml/cmH st: NotStopd t0: [18:10:00 05/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [18:10:00 05/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [18:10:00 05/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [18:10:00 05/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [18:10:00 05/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3.6 st: NotStopd t0: [18:10:00 05/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [18:10:00 05/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [18:10:00 05/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [18:10:00 05/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [18:10:00 05/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [18:10:00 05/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [18:10:00 05/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [18:10:00 05/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [18:10:00 05/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.7 u1: L/min st: NotStopd t0: [18:10:00 05/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [18:10:00 05/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [18:10:00 05/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [18:10:00 05/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [18:10:00 05/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [18:10:00 05/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [18:10:00 05/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [18:10:00 05/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [18:10:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [18:10:00 05/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [18:10:00 05/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [18:10:00 05/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [18:10:00 05/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [18:10:00 05/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [18:10:00 05/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [18:10:00 05/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [18:10:00 05/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [18:10:00 05/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [18:10:00 05/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [18:32:00 05/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: Positional st: NotStopd
t0: [20:00:00 05/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 05/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10.7143 u1: ml/cmH st: NotStopd t0: [20:00:00 05/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 05/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 05/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 05/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [20:00:00 05/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.5 st: NotStopd t0: [20:00:00 05/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 05/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 05/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 05/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 05/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 05/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 05/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 05/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [20:00:00 05/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [20:00:00 05/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 05/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 05/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [20:00:00 05/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [20:00:00 05/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [20:00:00 05/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [20:00:00 05/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [20:00:00 05/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 05/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 05/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 05/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 05/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [20:00:00 05/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 05/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 05/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 05/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 05/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 05/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 05/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 05/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [18:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [18:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [18:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [18:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [19:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [19:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [19:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [19:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [19:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [19:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [20:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [20:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.3333 u1: mmHg st: NotStopd t0: [20:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [20:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 05/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 05/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 05/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 05/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [21:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 05/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 05/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [21:00:00 05/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [21:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 05/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [21:00:00 05/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [21:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 05/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [21:00:00 05/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 05/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [21:00:00 05/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [21:00:00 05/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [21:00:00 05/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [21:00:00 05/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [21:00:00 05/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [21:00:00 05/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [21:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 05/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 05/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [21:00:00 05/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 05/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [21:00:00 05/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 05/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [21:00:00 05/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [21:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.3333 u1: mmHg st: NotStopd t0: [21:00:00 05/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [21:00:00 05/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 05/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 05/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [21:00:00 05/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [21:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 05/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [21:00:00 05/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [21:00:00 05/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 05/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [21:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [21:00:00 05/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [21:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 05/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [21:00:00 05/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [21:00:00 05/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [21:00:00 05/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [21:00:00 05/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [21:00:00 05/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [21:00:00 05/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [21:00:00 05/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 05/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 05/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [19:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [20:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [21:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [11:00:00 06/02/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 25 u1: mg
t0: [22:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [22:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [22:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78.3333 u1: mmHg st: NotStopd t0: [22:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [22:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 05/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 05/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 05/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 05/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 05/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 05/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [23:00:00 05/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 05/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [23:00:00 05/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.3333 u1: mmHg st: NotStopd t0: [23:00:00 05/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 05/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [23:00:00 05/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 05/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 06/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 06/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 9.67742 u1: ml/cmH st: NotStopd t0: [00:00:00 06/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 06/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 06/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 06/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [00:00:00 06/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.2 st: NotStopd t0: [00:00:00 06/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 06/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 06/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [00:00:00 06/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 06/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 06/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 06/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 06/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [00:00:00 06/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [00:00:00 06/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 06/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 06/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [00:00:00 06/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [00:00:00 06/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [00:00:00 06/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [00:00:00 06/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [00:00:00 06/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 06/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 06/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 06/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 06/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 308 u1: ml/B st: NotStopd t0: [00:00:00 06/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 06/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 06/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 06/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 06/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 06/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 06/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 06/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [00:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [00:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [00:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [00:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 06/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [01:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 06/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 06/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [01:00:00 06/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [01:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 06/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [01:00:00 06/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [01:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 06/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [01:00:00 06/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [01:00:00 06/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [01:00:00 06/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [01:00:00 06/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [01:00:00 06/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [01:00:00 06/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [01:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 06/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 06/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [01:00:00 06/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [01:00:00 06/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [01:00:00 06/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [01:00:00 06/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 06/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [01:00:00 06/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [01:00:00 06/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [01:00:00 06/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 06/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 06/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [01:00:00 06/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [01:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [01:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [01:00:00 06/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 06/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [01:00:00 06/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 06/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [01:00:00 06/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [01:00:00 06/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 06/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [01:00:00 06/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [01:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 06/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [01:00:00 06/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 06/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 06/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [01:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [01:00:00 06/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [01:00:00 06/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 06/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [01:00:00 06/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 06/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [01:00:00 06/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [01:00:00 06/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [01:00:00 06/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [01:00:00 06/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [01:00:00 06/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [01:00:00 06/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [01:00:00 06/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 06/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [01:00:00 06/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 06/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [01:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 06/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 110 rs: Manual st: NotStopd t0: [01:00:00 06/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [02:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [02:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [02:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [02:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [02:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [23:00:00 05/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [00:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [01:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [02:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 05/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1800 ap: none t0: [23:00:00 06/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 170 cv: 170 ap: none t0: [23:00:00 06/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -95 cv: -95 ap: none t0: [23:00:00 06/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 75 cv: 2400 ap: none t0: [23:00:00 06/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1800 ap: none t0: [23:00:00 06/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 170 cv: 2450 ap: none t0: [23:00:00 06/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -95 cv: -250 ap: none t0: [23:00:00 06/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 170 cv: 2650 ap: none t0: [23:00:00 06/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -95 cv: 8942.54 ap: carryForward
t0: [03:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [03:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [03:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [03:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [03:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 06/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 06/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10.7143 u1: ml/cmH st: NotStopd t0: [04:00:00 06/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 06/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 06/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 06/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [04:00:00 06/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.2 st: NotStopd t0: [04:00:00 06/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 06/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 06/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 06/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 06/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 06/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 06/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 06/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [04:00:00 06/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.8 u1: L/min st: NotStopd t0: [04:00:00 06/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 06/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 06/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [04:00:00 06/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [04:00:00 06/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [04:00:00 06/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [04:00:00 06/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:00:00 06/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 06/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 06/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 06/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 06/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 313 u1: ml/B st: NotStopd t0: [04:00:00 06/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 06/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 06/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 06/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 06/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 06/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:00:00 06/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 06/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 06/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [04:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 06/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 06/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 06/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 06/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 06/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [04:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.6667 u1: mmHg st: NotStopd t0: [04:00:00 06/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 06/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 06/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 06/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: RN v1: Waffles st: NotStopd t0: [04:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [04:00:00 06/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 06/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [04:00:00 06/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 06/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: Done t0: [05:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 06/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [05:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 06/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [05:00:00 06/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [05:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 06/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [05:00:00 06/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [05:00:00 06/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [05:00:00 06/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [05:00:00 06/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [05:00:00 06/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [05:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 86 u1: BPM st: NotStopd t0: [05:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 06/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 06/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [05:00:00 06/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [05:00:00 06/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [05:00:00 06/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [05:00:00 06/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [05:00:00 06/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 06/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [05:00:00 06/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 06/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 06/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [05:00:00 06/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [05:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 92 u2: mmHg st: NotStopd t0: [05:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 113.333 u1: mmHg st: NotStopd t0: [05:00:00 06/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [05:00:00 06/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 06/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [05:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 06/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 06/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 06/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [05:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [05:00:00 06/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [05:00:00 06/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 06/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [05:00:00 06/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [05:00:00 06/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [05:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 06/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [05:00:00 06/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [05:00:00 06/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [05:00:00 06/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [05:00:00 06/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 06/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [05:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 06/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [05:00:00 06/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [05:00:00 06/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [05:00:00 06/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [05:00:00 06/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [05:00:00 06/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [05:00:00 06/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [05:00:00 06/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [06:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 83 u1: BPM st: NotStopd t0: [06:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 89 u2: mmHg st: NotStopd t0: [06:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105.667 u1: mmHg st: NotStopd t0: [06:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [06:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [06:00:00 06/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [06:00:00 06/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.7778 u1: Deg. C st: NotStopd t0: [06:00:00 06/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 100 u1: Deg. F st: NotStopd t0: [06:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [04:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [05:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [06:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 06/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 200 ap: none
t0: [05:30:00 06/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 13.4 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.2 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 13.4 rs: Final st: NotStopd
t0: [05:30:00 06/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 102 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 100 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 140 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 102 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 100 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 rs: Final st: NotStopd t0: [05:30:00 06/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 140 rs: Final st: NotStopd
t0: [07:00:00 06/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [07:00:00 06/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12 u1: ml/cmH st: NotStopd t0: [07:00:00 06/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [07:00:00 06/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [07:00:00 06/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [07:00:00 06/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [07:00:00 06/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [07:00:00 06/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [07:00:00 06/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [07:00:00 06/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:00:00 06/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:00:00 06/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [07:00:00 06/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:00:00 06/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:00:00 06/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [07:00:00 06/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.3 u1: L/min st: NotStopd t0: [07:00:00 06/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:00:00 06/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [07:00:00 06/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [07:00:00 06/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [07:00:00 06/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [07:00:00 06/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [07:00:00 06/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [07:00:00 06/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:00:00 06/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [07:00:00 06/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [07:00:00 06/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 290 u1: ml/B st: NotStopd t0: [07:00:00 06/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [07:00:00 06/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [07:00:00 06/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [07:00:00 06/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [07:00:00 06/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [07:00:00 06/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [07:00:00 06/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [07:00:00 06/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [07:45:00 06/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.2 rs: Final st: NotStopd t0: [07:45:00 06/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 13.2 rs: Final st: NotStopd t0: [07:45:00 06/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 25 u1: % rs: Final st: NotStopd t0: [07:45:00 06/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 7.7 u1: gm/dl rs: Final st: NotStopd t0: [07:45:00 06/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 665 rs: Final st: NotStopd t0: [07:45:00 06/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.8 u1: /mic l rs: Final st: NotStopd t0: [07:45:00 06/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.2 rs: Final st: NotStopd
t0: [09:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 06/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [09:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 06/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [09:00:00 06/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [09:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 06/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [09:00:00 06/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [09:00:00 06/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [09:00:00 06/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [09:00:00 06/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [09:00:00 06/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [09:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [09:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 06/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 06/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [09:00:00 06/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [09:00:00 06/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [09:00:00 06/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [09:00:00 06/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [09:00:00 06/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [09:00:00 06/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [09:00:00 06/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [09:00:00 06/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 06/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [09:00:00 06/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 06/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 06/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [09:00:00 06/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [09:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [09:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [09:00:00 06/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [09:00:00 06/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [09:00:00 06/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [09:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 06/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 06/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 06/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [09:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 6 u1: BPM st: NotStopd t0: [09:00:00 06/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [09:00:00 06/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 06/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 06/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [09:00:00 06/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [09:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 06/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [09:00:00 06/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [09:00:00 06/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Liquid st: NotStopd t0: [09:00:00 06/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [09:00:00 06/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 06/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [09:00:00 06/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [09:00:00 06/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [09:00:00 06/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [09:00:00 06/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [09:00:00 06/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [09:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 06/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [09:00:00 06/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [09:00:00 06/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [09:00:00 06/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [09:00:00 06/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [09:00:00 06/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [09:00:00 06/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [09:00:00 06/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd
t0: [09:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 225 vu: ml
tf: [12:00:00 07/02/2016] pt: Unit Dose rt: IV fr: QD fs: 10 dn: 1 m1: Bumetanide v1: 2 u1: mg tf: [12:00:00 07/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Metolazone v1: 5 u1: mg tf: [11:00:00 09/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Warfarin v1: 2 u1: mg
t0: [10:30:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:30:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:30:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:30:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:30:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [10:30:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:30:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [10:30:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97.6667 u1: mmHg st: NotStopd t0: [10:30:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:30:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [10:30:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:30:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 06/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [11:00:00 06/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 10.7143 u1: ml/cmH st: NotStopd t0: [11:00:00 06/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [11:00:00 06/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [11:00:00 06/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [11:00:00 06/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [11:00:00 06/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [11:00:00 06/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [11:00:00 06/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:00:00 06/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 06/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:00:00 06/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [11:00:00 06/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:00:00 06/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:00:00 06/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [11:00:00 06/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.2 u1: L/min st: NotStopd t0: [11:00:00 06/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 06/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 06/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 33 u1: cmH2O st: NotStopd t0: [11:00:00 06/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [11:00:00 06/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [11:00:00 06/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [11:00:00 06/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [11:00:00 06/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [11:00:00 06/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [11:00:00 06/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [11:00:00 06/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [11:00:00 06/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [11:00:00 06/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [11:00:00 06/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [11:00:00 06/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [11:00:00 06/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
tf: [11:00:00 07/02/2016] pt: Unit Dose rt: PO fr: ONCE fs: 12 dn: 1 m1: Potassium Chloride v1: 20 u1: mEq
t0: [12:00:00 06/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 23 st: NotStopd t0: [12:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [12:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 06/02/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [12:00:00 06/02/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [12:00:00 06/02/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [12:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [12:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [12:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [12:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [12:00:00 06/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [12:00:00 06/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [12:00:00 06/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [12:00:00 06/02/2016] id: Trach Size el: 0 cu: MICU cg: RN v1: #8 st: NotStopd t0: [12:00:00 06/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Portex st: NotStopd t0: [12:00:00 06/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [12:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 225 vu: ml
t0: [14:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [14:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [14:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.3333 u1: mmHg st: NotStopd t0: [14:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [14:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [15:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [15:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [15:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [15:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [15:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [15:00:00 06/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [15:00:00 06/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12 u1: ml/cmH st: NotStopd t0: [15:00:00 06/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [15:00:00 06/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [15:00:00 06/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [15:00:00 06/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [15:00:00 06/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [15:00:00 06/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [15:00:00 06/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [15:00:00 06/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [15:00:00 06/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [15:00:00 06/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [15:00:00 06/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [15:00:00 06/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [15:00:00 06/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [15:00:00 06/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [15:00:00 06/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [15:00:00 06/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [15:00:00 06/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [15:00:00 06/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [15:00:00 06/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [15:00:00 06/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [15:00:00 06/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [15:00:00 06/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [15:00:00 06/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [15:00:00 06/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [15:00:00 06/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [15:00:00 06/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [15:00:00 06/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [15:00:00 06/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [15:00:00 06/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [15:00:00 06/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
tf: [22:00:00 12/02/2016] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Neutra-Phos v1: 2 u1: PKT
t0: [16:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [16:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [16:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100.333 u1: mmHg st: NotStopd t0: [16:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [16:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [18:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [18:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [18:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103.333 u1: mmHg st: NotStopd t0: [18:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [18:00:00 06/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 06/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 06/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [16:00:00 06/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [18:00:00 06/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 143 rs: Manual st: NotStopd
t0: [18:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [23:00:00 06/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 250 ap: none
t0: [19:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 06/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [19:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [19:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104.667 u1: mmHg st: NotStopd t0: [19:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [19:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 06/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [20:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [20:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [20:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [20:00:00 06/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 06/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 13.0435 u1: ml/cmH st: NotStopd t0: [20:00:00 06/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 06/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 06/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [20:00:00 06/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [20:00:00 06/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [20:00:00 06/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 06/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 06/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 06/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 06/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 06/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 06/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 06/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [20:00:00 06/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [20:00:00 06/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 06/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 06/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [20:00:00 06/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [20:00:00 06/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 0 u1: . st: NotStopd t0: [20:00:00 06/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [20:00:00 06/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [20:00:00 06/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 06/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 06/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 06/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [20:00:00 06/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 328 u1: ml/B st: NotStopd t0: [20:00:00 06/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 06/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 06/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 06/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 06/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 06/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 06/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 06/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 06/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 06/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 06/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 06/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 06/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 06/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 06/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [20:00:00 06/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 06/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 06/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 06/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 06/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 06/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 06/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 06/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 06/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 06/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 06/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 06/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 06/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 06/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [20:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [20:00:00 06/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 06/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 06/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 06/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 06/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 06/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 06/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 06/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 06/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 06/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 06/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 06/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 06/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 06/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 06/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 06/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 06/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 06/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 06/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 06/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 06/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Comp. Immobile st: NotStopd t0: [20:00:00 06/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 06/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 06/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [20:00:00 06/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [21:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 06/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [21:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [21:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.6667 u1: mmHg st: NotStopd t0: [21:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 5 u1: BPM st: NotStopd t0: [21:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
tf: [20:00:00 07/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 21 dn: 1 m1: Bumetanide v1: 2 u1: mg tf: [20:00:00 07/02/2016] pt: Unit Dose rt: PO fr: ONCE fs: 21 dn: 1 m1: Metolazone v1: 5 u1: mg
tf: [13:00:00 21/02/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 50 u1: mg
t0: [21:00:00 06/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [21:00:00 06/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [21:00:00 06/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [22:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [22:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 06/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [22:00:00 06/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86.3333 u1: mmHg st: NotStopd t0: [22:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [22:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [23:00:00 06/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 06/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 06/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 06/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [23:00:00 06/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 06/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 06/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 06/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [23:00:00 06/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 06/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 06/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [23:00:00 06/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 07/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 07/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15 u1: ml/cmH st: NotStopd t0: [00:00:00 07/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 07/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 07/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [00:00:00 07/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [00:00:00 07/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [00:00:00 07/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 07/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 07/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 07/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 07/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 07/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 07/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 07/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [00:00:00 07/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.9 u1: L/min st: NotStopd t0: [00:00:00 07/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 07/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 07/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [00:00:00 07/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [00:00:00 07/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 11 u1: BPM st: NotStopd t0: [00:00:00 07/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [00:00:00 07/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 07/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 07/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 07/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 07/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 309 u1: ml/B st: NotStopd t0: [00:00:00 07/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 07/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 07/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 07/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 07/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 07/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 07/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 07/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [00:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [00:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.6667 u1: mmHg st: NotStopd t0: [00:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [00:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [01:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [01:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.6667 u1: mmHg st: NotStopd t0: [01:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [01:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 07/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [02:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [02:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [02:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 13 u1: BPM st: NotStopd t0: [02:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [01:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [02:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [03:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 06/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 350 ap: none t0: [23:00:00 07/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 100 cv: 100 ap: none t0: [23:00:00 07/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -14 cv: -14 ap: none t0: [23:00:00 07/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 86 cv: 2429 ap: none t0: [23:00:00 07/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 280 ap: none t0: [23:00:00 07/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1800 ap: none t0: [23:00:00 07/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 100 cv: 2210 ap: none t0: [23:00:00 07/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -14 cv: -581 ap: none t0: [23:00:00 07/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 100 cv: 3010 ap: none t0: [23:00:00 07/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -14 cv: 8361.54 ap: carryForward
t0: [02:00:00 07/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [02:00:00 07/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [02:00:00 07/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [02:00:00 07/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [02:00:00 07/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [02:00:00 07/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [02:00:00 07/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [02:00:00 07/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [02:00:00 07/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [02:00:00 07/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [02:00:00 07/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [02:00:00 07/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [02:00:00 07/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [02:00:00 07/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [02:00:00 07/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [02:00:00 07/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [02:00:00 07/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 07/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [02:00:00 07/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [02:00:00 07/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [02:00:00 07/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Dozing Intermit st: NotStopd t0: [02:00:00 07/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [02:00:00 07/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [02:00:00 07/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [02:00:00 07/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [02:00:00 07/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [02:00:00 07/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [02:00:00 07/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [02:00:00 07/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [02:00:00 07/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 07/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 07/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [02:00:00 07/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [02:00:00 07/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [02:00:00 07/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [02:00:00 07/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [02:00:00 07/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [02:00:00 07/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [02:00:00 07/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [02:00:00 07/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [02:00:00 07/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [02:00:00 07/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [02:00:00 07/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [02:00:00 07/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [02:00:00 07/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [02:00:00 07/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [02:00:00 07/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [02:00:00 07/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [02:00:00 07/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [03:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [03:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [03:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.3333 u1: mmHg st: NotStopd t0: [03:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [03:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 07/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 07/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15 u1: ml/cmH st: NotStopd t0: [04:00:00 07/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 07/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 07/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [04:00:00 07/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [04:00:00 07/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [04:00:00 07/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 07/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 07/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [04:00:00 07/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 07/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 07/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 07/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 07/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [04:00:00 07/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [04:00:00 07/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 07/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 07/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [04:00:00 07/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [04:00:00 07/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [04:00:00 07/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [04:00:00 07/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 07/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 07/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 07/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [04:00:00 07/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 365 u1: ml/B st: NotStopd t0: [04:00:00 07/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 07/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 07/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 07/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 07/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 07/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:00:00 07/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 07/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 07/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 07/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 07/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 07/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 07/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 07/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [04:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [04:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 07/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 07/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 07/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [04:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [04:00:00 07/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 07/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 07/02/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [04:00:00 07/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 07/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [04:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [06:30:00 07/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [06:30:00 07/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [06:30:00 07/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [06:30:00 07/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd
t0: [07:00:00 07/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [07:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 07/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [07:00:00 07/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [07:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 07/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [07:00:00 07/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [07:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 07/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [07:00:00 07/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 07/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [07:00:00 07/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [07:00:00 07/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [07:00:00 07/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [07:00:00 07/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [07:00:00 07/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [07:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [07:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 07/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [07:00:00 07/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [07:00:00 07/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [07:00:00 07/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [07:00:00 07/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [07:00:00 07/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 07/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [07:00:00 07/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [07:00:00 07/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [07:00:00 07/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [07:00:00 07/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [07:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [07:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79.6667 u1: mmHg st: NotStopd t0: [07:00:00 07/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [07:00:00 07/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [07:00:00 07/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [07:00:00 07/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [07:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 07/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [07:00:00 07/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [07:00:00 07/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [07:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [07:00:00 07/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [07:00:00 07/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 07/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [07:00:00 07/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [07:00:00 07/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [07:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 07/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [07:00:00 07/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [07:00:00 07/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [07:00:00 07/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [07:00:00 07/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [07:00:00 07/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [07:00:00 07/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [07:00:00 07/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [07:00:00 07/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [07:00:00 07/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [07:00:00 07/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [07:00:00 07/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [07:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [07:00:00 07/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [07:00:00 07/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [07:00:00 07/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [07:00:00 07/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [07:00:00 07/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [07:00:00 07/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [07:00:00 07/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [07:00:00 07/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [07:00:00 07/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 07/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 07/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd
t0: [07:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 225 vu: ml
t0: [08:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [08:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 07/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 87 u2: mmHg st: NotStopd t0: [08:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 111.667 u1: mmHg st: NotStopd t0: [08:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [08:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [08:00:00 07/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:00:00 07/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 20 u1: ml/cmH st: NotStopd t0: [08:00:00 07/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 07/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 07/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [08:00:00 07/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [08:00:00 07/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [08:00:00 07/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 07/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 07/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 07/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 07/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [08:00:00 07/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 07/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 07/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [08:00:00 07/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.4 u1: L/min st: NotStopd t0: [08:00:00 07/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 07/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 07/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [08:00:00 07/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [08:00:00 07/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [08:00:00 07/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [08:00:00 07/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 07/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 07/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 330 u1: ml/B st: NotStopd t0: [08:00:00 07/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:00:00 07/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 07/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 07/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 07/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 07/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 07/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 07/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:20:00 07/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 10.7 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 10.7 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 24.8 u1: % rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 7.6 u1: gm/dl rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 770 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.73 u1: /mic l rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 10.7 rs: Final st: NotStopd
t0: [09:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [09:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [09:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.6667 u1: mmHg st: NotStopd t0: [09:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [09:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [08:20:00 07/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 13.9 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.3 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 13.9 rs: Final st: NotStopd
t0: [08:20:00 07/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 u1: mEq/L rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 34 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 98 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.5 u1: mEq/L rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 rs: Final st: NotStopd t0: [08:20:00 07/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 138 rs: Final st: NotStopd
tf: [21:00:00 26/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Lisinopril v1: 10 u1: mg
t0: [10:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 07/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 07/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [10:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 07/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 07/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [10:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.3333 u1: mmHg st: NotStopd t0: [10:00:00 07/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 07/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 07/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [10:00:00 07/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [10:00:00 07/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 07/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [10:00:00 07/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [10:00:00 07/02/2016] id: BSA - English el: 0 cu: MICU cg: RN v1: 1.00602 u1: m2 st: NotStopd t0: [10:00:00 07/02/2016] id: BSA - Metric el: 0 cu: MICU cg: RN v1: 1.17951 u1: m2 st: NotStopd t0: [10:00:00 07/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 07/02/2016] id: Daily Weight el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [10:00:00 07/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done
t0: [10:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [11:00:00 07/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [11:00:00 07/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15 u1: ml/cmH st: NotStopd t0: [11:00:00 07/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [11:00:00 07/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [11:00:00 07/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 50 u1: cmH2O st: NotStopd t0: [11:00:00 07/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [11:00:00 07/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [11:00:00 07/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 07/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [11:00:00 07/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [11:00:00 07/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.6 u1: L/min st: NotStopd t0: [11:00:00 07/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 07/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 07/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [11:00:00 07/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [11:00:00 07/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [11:00:00 07/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [11:00:00 07/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [11:00:00 07/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [11:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [11:00:00 07/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [11:00:00 07/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [11:00:00 07/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [11:00:00 07/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [11:00:00 07/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [11:00:00 07/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [11:00:00 07/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [11:00:00 07/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [11:00:00 07/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
tf: [10:00:00 08/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 11 dn: 1 m1: Magnesium Sulfate v1: 4 u1: gm m2: D5W v2: 250 u2: ml tf: [10:00:00 08/02/2016] pt: Unit Dose rt: PO fr: ONCE fs: 11 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq
t0: [11:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [11:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [11:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [11:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [11:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [11:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [12:00:00 07/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 07/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 07/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 07/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: RN v1: 135 rs: Manual st: NotStopd t0: [12:00:00 07/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 07/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 07/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 07/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [12:00:00 07/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 07/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 07/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 07/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [12:00:00 07/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 07/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [12:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 07/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 07/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 07/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 07/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 07/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 07/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 07/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 07/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [12:00:00 07/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 07/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 07/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 07/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 07/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 07/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [12:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [12:00:00 07/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 07/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 07/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 07/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [12:00:00 07/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 07/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 07/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [12:00:00 07/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 07/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 07/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 07/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 07/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 07/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 07/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 07/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 07/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 07/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [12:00:00 07/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [12:00:00 07/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 07/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 07/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 07/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 07/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [12:00:00 07/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: RN v1: 135 rs: Manual st: NotStopd
t0: [12:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [12:00:00 07/02/2016] id: HOB el: 0 cu: MICU cg: RN st: NotStopd
tf: [12:00:00 08/02/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Furosemide v1: 100 u1: mg m2: D5W v2: 50 u2: ml
t0: [13:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [13:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [13:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 108.333 u1: mmHg st: NotStopd t0: [13:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [13:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [13:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [14:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [14:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [14:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.3333 u1: mmHg st: NotStopd t0: [14:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [14:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [14:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
id: Lasix el: 200 cu: MICU cg: RN io: D5W 50.0ml + 100mghr Lasix IV Infusions am: 100 du: mghr rt: IV Drip
io: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ra: 10 ru: ml/hr io: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ra: 1 ru: ml/hr
id: D5W el: 2 cu: MICU cg: RN io: D5W 50.0ml + 100mghr Lasix IV Infusions vo: 50 du: ml rt: Intravenous Push id: .9% Normal Saline el: 1 cu: MICU cg: RN io: .9% Normal Saline 250.0ml IV Infusions vo: 250 du: ml rt: Intravenous Push
t0: [14:00:00 07/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vu: ml nb: 1 t0: [14:00:00 07/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vu: ml nb: 1
t0: [14:00:00 07/02/2016] tf: [08:00:00 15/02/2016] dt: 11160 id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [15:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [15:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.3333 u1: mmHg st: NotStopd t0: [15:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [15:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [15:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 07/02/2016] tf: [10:00:00 21/02/2016] dt: 19860 id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 07/02/2016] tf: [09:00:00 09/02/2016] dt: 2520 id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [15:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [15:00:00 07/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 07/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [15:00:00 07/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 14.2857 u1: ml/cmH st: NotStopd t0: [15:00:00 07/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [15:00:00 07/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [15:00:00 07/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [15:00:00 07/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [15:00:00 07/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [15:00:00 07/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [15:00:00 07/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [15:00:00 07/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [15:00:00 07/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [15:00:00 07/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [15:00:00 07/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [15:00:00 07/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [15:00:00 07/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [15:00:00 07/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.9 u1: L/min st: NotStopd t0: [15:00:00 07/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [15:00:00 07/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [15:00:00 07/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [15:00:00 07/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [15:00:00 07/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [15:00:00 07/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [15:00:00 07/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [15:00:00 07/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [15:00:00 07/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 319 u1: ml/B st: NotStopd t0: [15:00:00 07/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [15:00:00 07/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [15:00:00 07/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [15:00:00 07/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [15:00:00 07/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [15:00:00 07/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [15:00:00 07/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [15:00:00 07/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [10:00:00 07/02/2016] id: Trach Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 07/02/2016] id: HOB el: 0 cu: MICU cg: RN st: NotStopd t0: [13:00:00 07/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 07/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 07/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 07/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 07/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 07/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 07/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 07/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 07/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 07/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 07/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 07/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 07/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 07/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 07/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [16:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 07/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 07/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 07/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 07/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 07/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 07/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 07/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 07/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 07/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 07/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 07/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 07/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 07/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 07/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [16:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [16:00:00 07/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 07/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 07/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 07/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [16:00:00 07/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 07/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 07/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [16:00:00 07/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 07/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 07/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 07/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 07/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 07/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [16:00:00 07/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [16:00:00 07/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 07/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [16:00:00 07/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 07/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 07/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 07/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6111 u1: Deg. C st: NotStopd t0: [16:00:00 07/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.7 u1: Deg. F st: NotStopd t0: [16:00:00 07/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 07/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 07/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 07/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 07/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [16:00:00 07/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 07/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 07/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 07/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 07/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 07/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [16:00:00 07/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [16:00:00 07/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 07/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [16:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [16:00:00 07/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 07/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 07/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 07/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 07/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 07/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 07/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [16:00:00 07/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [16:00:00 07/02/2016] id: Trach Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 07/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 07/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [17:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [17:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [17:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.6667 u1: mmHg st: NotStopd t0: [17:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [17:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [17:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 07/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 07/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [17:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [17:00:00 07/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:00:00 07/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: CoWkr v1: 138 rs: Manual st: NotStopd
t0: [18:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [18:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [18:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.3333 u1: mmHg st: NotStopd t0: [18:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [18:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [18:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 07/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 07/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [18:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [18:00:00 07/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 07/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 800 ap: none
t0: [19:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [19:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [19:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.6667 u1: mmHg st: NotStopd t0: [19:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [19:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 16 u1: BPM st: NotStopd t0: [19:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 07/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [20:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [20:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97 u1: mmHg st: NotStopd t0: [20:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [20:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [20:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 07/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [19:00:00 07/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [19:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [20:00:00 07/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 07/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [20:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [19:00:00 07/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 07/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 07/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 07/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15 u1: ml/cmH st: NotStopd t0: [20:00:00 07/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 07/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 07/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 07/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 07/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [20:00:00 07/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 07/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 07/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 07/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 07/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 07/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 07/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 07/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 07/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.1 u1: L/min st: NotStopd t0: [20:00:00 07/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 07/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 07/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [20:00:00 07/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [20:00:00 07/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [20:00:00 07/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [20:00:00 07/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 07/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 07/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 07/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [20:00:00 07/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 298 u1: ml/B st: NotStopd t0: [20:00:00 07/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 07/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 07/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 07/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 07/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 07/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 07/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 07/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [21:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [21:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [21:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [21:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [21:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [21:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 07/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 07/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [21:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [21:00:00 07/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 07/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 07/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 07/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 07/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 07/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 07/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 07/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 07/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [20:00:00 07/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 07/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 07/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 07/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 07/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 07/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 07/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 07/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 07/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 07/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 07/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 07/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 07/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 07/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 07/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 07/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 07/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 07/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 07/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 07/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 07/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 07/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 07/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 07/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 07/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 07/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 07/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 07/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 07/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 07/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 07/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 07/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 07/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 07/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 07/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [20:00:00 07/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [21:00:00 07/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [21:00:00 07/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5 u1: Deg. C st: NotStopd t0: [21:00:00 07/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.5 u1: Deg. F st: NotStopd t0: [22:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 07/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 07/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [22:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 07/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [22:00:00 07/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [22:00:00 07/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [22:00:00 07/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 07/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [22:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [22:00:00 07/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 07/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [22:00:00 07/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [22:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [22:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [22:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 07/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [22:00:00 07/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [22:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 07/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 07/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [22:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [22:00:00 07/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 07/02/2016] id: Free Water Bolus PO/Gastric el: 1 cu: MICU cg: -1 ai: 274 vo: 0 st: D/C'd
t0: [23:00:00 07/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 07/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 07/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [23:00:00 07/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 07/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 07/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 07/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [23:00:00 07/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 07/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [23:00:00 07/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [23:00:00 07/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 07/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [23:00:00 07/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [23:00:00 07/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 07/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 07/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 07/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [23:00:00 07/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 07/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 07/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 11 cv: 349 ap: none
t0: [00:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [00:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [00:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [00:00:00 08/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 08/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 08/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [00:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 08/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 08/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 08/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 08/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [00:00:00 08/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 08/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 08/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [00:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 08/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 08/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 08/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 08/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 08/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [00:00:00 08/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 08/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 08/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 08/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 08/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 08/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [00:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.3333 u1: mmHg st: NotStopd t0: [00:00:00 08/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 08/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [00:00:00 08/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 08/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 08/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [00:00:00 08/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 08/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 08/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 08/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 08/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 08/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 08/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 08/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 08/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 08/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 08/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 08/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 08/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [00:00:00 08/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 08/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 08/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 08/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 08/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 08/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [00:00:00 08/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [00:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 08/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 08/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 17.6471 u1: ml/cmH st: NotStopd t0: [00:00:00 08/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 08/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 08/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 08/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 08/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [00:00:00 08/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 08/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 08/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 08/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 08/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 08/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 08/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 08/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 08/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [00:00:00 08/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 08/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 08/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [00:00:00 08/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [00:00:00 08/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [00:00:00 08/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [00:00:00 08/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 08/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 08/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 08/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 08/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 314 u1: ml/B st: NotStopd t0: [00:00:00 08/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 08/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 08/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 08/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 08/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 08/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 08/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 08/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [01:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [01:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [01:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [01:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97.3333 u1: mmHg st: NotStopd t0: [01:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [01:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [01:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [01:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [01:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [02:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [02:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [02:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [02:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [02:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [02:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [02:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [02:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 08/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [02:00:00 08/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [02:00:00 08/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [03:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [03:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [03:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [03:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103.667 u1: mmHg st: NotStopd t0: [03:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [03:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [03:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [03:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [03:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:45:00 08/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 99 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 131 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 99 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 131 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd
t0: [00:00:00 08/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 08/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 08/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 08/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 08/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 08/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [00:00:00 08/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [00:00:00 08/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [03:00:00 08/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [03:00:00 08/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [03:00:00 08/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [03:00:00 08/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [03:00:00 08/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [03:00:00 08/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [03:00:00 08/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [03:00:00 08/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 08/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 08/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 08/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [04:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 08/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 08/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 08/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 08/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [04:00:00 08/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 08/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 08/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [04:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 08/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 08/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 08/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 08/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 08/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [04:00:00 08/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 08/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 08/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 08/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [04:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.6667 u1: mmHg st: NotStopd t0: [04:00:00 08/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 08/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [04:00:00 08/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 08/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [04:00:00 08/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 08/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 08/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 08/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 08/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 08/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [04:00:00 08/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 08/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 08/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 08/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 08/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 08/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 08/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [04:00:00 08/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [04:00:00 08/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [04:00:00 08/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [04:00:00 08/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [04:00:00 08/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [04:00:00 08/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [04:00:00 08/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [04:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [04:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [04:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:45:00 08/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.4 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 9.4 rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 25.5 u1: % rs: Final st: NotStopd t0: [03:45:00 08/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.4 rs: Final st: NotStopd
t0: [04:00:00 08/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 08/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.5 u1: ml/cmH st: NotStopd t0: [04:00:00 08/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 08/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 08/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 08/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 08/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [04:00:00 08/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 08/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 08/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [04:00:00 08/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 08/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 08/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 08/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 08/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [04:00:00 08/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.2 u1: L/min st: NotStopd t0: [04:00:00 08/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 08/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 08/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [04:00:00 08/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [04:00:00 08/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [04:00:00 08/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [04:00:00 08/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 08/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 08/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 08/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 08/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [04:00:00 08/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 08/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 08/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 08/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 08/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 08/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:00:00 08/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 08/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [05:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [05:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [05:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97.3333 u1: mmHg st: NotStopd t0: [05:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [05:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [05:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [06:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [06:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [06:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip t0: [06:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [05:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [05:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [06:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [06:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [06:00:00 08/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [06:00:00 08/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [06:00:00 08/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd
t0: [03:45:00 08/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 810 rs: Final st: NotStopd
t0: [06:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [06:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.3333 u1: mmHg st: NotStopd t0: [07:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [07:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [07:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [07:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [07:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [07:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [07:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 08/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 08/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 08/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 08/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 08/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 08/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 08/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 08/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 08/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [08:00:00 08/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 08/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 08/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 08/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [08:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 08/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 08/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 08/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 08/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 08/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 08/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 08/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 08/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 08/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 08/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 08/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 08/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 08/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 08/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 08/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [08:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [08:00:00 08/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 08/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 08/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 08/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 08/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 08/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [08:00:00 08/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 08/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [08:00:00 08/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 08/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 08/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 08/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 08/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 08/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 08/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [08:00:00 08/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 08/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 08/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 08/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2778 u1: Deg. C st: NotStopd t0: [08:00:00 08/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.1 u1: Deg. F st: NotStopd t0: [08:00:00 08/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [08:00:00 08/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 08/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 08/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 08/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 08/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 08/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [08:00:00 08/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 08/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 08/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 08/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 08/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 08/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 08/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [08:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [08:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:48:00 08/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:48:00 08/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.5 u1: ml/cmH st: NotStopd t0: [08:48:00 08/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: Positional st: NotStopd t0: [08:48:00 08/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:48:00 08/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [08:48:00 08/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:48:00 08/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [08:48:00 08/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:48:00 08/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:48:00 08/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:48:00 08/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:48:00 08/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [08:48:00 08/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:48:00 08/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:48:00 08/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [08:48:00 08/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.9 u1: L/min st: NotStopd t0: [08:48:00 08/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:48:00 08/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:48:00 08/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [08:48:00 08/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [08:48:00 08/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [08:48:00 08/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [08:48:00 08/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [08:48:00 08/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:48:00 08/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:48:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:48:00 08/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [08:48:00 08/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [08:48:00 08/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:48:00 08/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:48:00 08/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:48:00 08/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:48:00 08/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:48:00 08/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:48:00 08/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:48:00 08/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:48:00 08/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RRT v1: Rhonchi st: NotStopd t0: [08:48:00 08/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RRT v1: Rhonchi st: NotStopd t0: [08:48:00 08/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RRT v1: Rhonchi st: NotStopd t0: [08:48:00 08/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RRT v1: Rhonchi st: NotStopd t0: [08:48:00 08/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RRT v1: Tachypneic st: NotStopd
t0: [08:00:00 08/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 08/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 08/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 08/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [09:00:00 08/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [09:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [09:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [09:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [09:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [09:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [09:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [09:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [09:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 08/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [10:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 08/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [10:00:00 08/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [10:00:00 08/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [10:00:00 08/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 08/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 113 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [10:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77 u1: mmHg st: NotStopd t0: [10:00:00 08/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 08/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [10:00:00 08/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [10:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [10:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 08/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [10:00:00 08/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [10:00:00 08/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [10:00:00 08/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [10:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [10:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [10:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:00:00 08/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [11:00:00 08/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [11:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [11:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [11:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86.3333 u1: mmHg st: NotStopd t0: [11:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [11:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [11:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [11:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [11:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [11:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 08/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 08/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 08/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 08/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 08/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [12:00:00 08/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 08/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 08/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [12:00:00 08/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 08/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 08/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 08/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [12:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 08/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 08/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 08/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 08/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 08/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 08/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [12:00:00 08/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 08/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [12:00:00 08/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [12:00:00 08/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 08/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 08/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [12:00:00 08/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 08/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [12:00:00 08/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 08/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 08/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 08/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 08/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 08/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [12:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [12:00:00 08/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 08/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 08/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 08/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [12:00:00 08/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 08/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [12:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [12:00:00 08/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 08/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 08/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [12:00:00 08/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 08/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 08/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 08/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 08/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 08/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 08/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [12:00:00 08/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 08/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 08/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [12:00:00 08/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 08/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 08/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 08/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 08/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [12:00:00 08/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [12:00:00 08/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [12:00:00 08/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [12:00:00 08/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [12:00:00 08/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [12:00:00 08/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [12:00:00 08/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [12:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [12:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [12:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 08/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 115 rs: Manual st: NotStopd
t0: [11:30:00 08/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 14.3 rs: Final st: NotStopd t0: [11:30:00 08/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [11:30:00 08/02/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 31 rs: Final st: NotStopd t0: [11:30:00 08/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [11:30:00 08/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14.3 rs: Final st: NotStopd t0: [11:30:00 08/02/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 31 rs: Final st: NotStopd
t0: [12:39:00 08/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:39:00 08/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15.7895 u1: ml/cmH st: NotStopd t0: [12:39:00 08/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: Positional st: NotStopd t0: [12:39:00 08/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:39:00 08/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [12:39:00 08/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [12:39:00 08/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [12:39:00 08/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:39:00 08/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:39:00 08/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.3 u1: Deg. C st: NotStopd t0: [12:39:00 08/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:39:00 08/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [12:39:00 08/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:39:00 08/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:39:00 08/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [12:39:00 08/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.3 u1: L/min st: NotStopd t0: [12:39:00 08/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:39:00 08/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:39:00 08/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [12:39:00 08/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [12:39:00 08/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 17 u1: BPM st: NotStopd t0: [12:39:00 08/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [12:39:00 08/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:39:00 08/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:39:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:39:00 08/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [12:39:00 08/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [12:39:00 08/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:39:00 08/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:39:00 08/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:39:00 08/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:39:00 08/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:39:00 08/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:39:00 08/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [12:39:00 08/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
tf: [08:00:00 09/02/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Furosemide v1: 100 u1: mg m2: D5W v2: 50 u2: ml
t0: [13:00:00 08/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [13:00:00 08/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [13:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [13:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [13:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.3333 u1: mmHg st: NotStopd t0: [13:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [13:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [13:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 08/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [13:00:00 08/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5 u1: Deg. C st: NotStopd t0: [13:00:00 08/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.5 u1: Deg. F st: NotStopd t0: [13:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [13:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [13:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [14:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [14:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [14:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100.333 u1: mmHg st: NotStopd t0: [14:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [14:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [14:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 08/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [14:00:00 08/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [14:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [14:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [14:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 08/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [15:00:00 08/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [15:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 08/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [15:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 08/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [15:00:00 08/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [15:00:00 08/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [15:00:00 08/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 08/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [15:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86.6667 u1: mmHg st: NotStopd t0: [15:00:00 08/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 08/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [15:00:00 08/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [15:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [15:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [15:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 08/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [15:00:00 08/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [15:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml t0: [15:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [15:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 08/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 08/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 08/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 08/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 08/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 08/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 08/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [16:00:00 08/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 08/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 08/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [16:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 08/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 08/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 08/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 08/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 08/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 08/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [16:00:00 08/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 08/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 08/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 08/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 08/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 08/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 08/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 08/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [16:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.3333 u1: mmHg st: NotStopd t0: [16:00:00 08/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 08/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 08/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [16:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [16:00:00 08/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 08/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 08/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [16:00:00 08/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 08/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 08/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 08/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 08/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 08/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 08/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [16:00:00 08/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 08/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 08/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 08/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 08/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 08/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 08/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [16:00:00 08/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 08/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 08/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 08/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 08/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 08/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [16:00:00 08/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [16:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.5 vu: ml t0: [16:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [16:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 08/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 600 ap: none
t0: [17:00:00 08/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [17:00:00 08/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [17:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [17:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [17:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 82.6667 u1: mmHg st: NotStopd t0: [17:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [17:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [17:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 08/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [17:00:00 08/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [17:00:00 08/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [17:00:00 08/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [17:00:00 08/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [17:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.5 vu: ml t0: [17:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [17:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [17:37:00 08/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [17:37:00 08/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15.7895 u1: ml/cmH st: NotStopd t0: [17:37:00 08/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: Positional st: NotStopd t0: [17:37:00 08/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:37:00 08/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [17:37:00 08/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [17:37:00 08/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [17:37:00 08/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [17:37:00 08/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [17:37:00 08/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [17:37:00 08/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:37:00 08/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [17:37:00 08/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 8 v2: Albuterol st: NotStopd t0: [17:37:00 08/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:37:00 08/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [17:37:00 08/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.5 u1: L/min st: NotStopd t0: [17:37:00 08/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:37:00 08/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:37:00 08/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [17:37:00 08/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [17:37:00 08/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [17:37:00 08/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [17:37:00 08/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [17:37:00 08/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [17:37:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [17:37:00 08/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [17:37:00 08/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [17:37:00 08/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 280 u1: ml/B st: NotStopd t0: [17:37:00 08/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [17:37:00 08/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [17:37:00 08/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [17:37:00 08/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [17:37:00 08/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [17:37:00 08/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [17:37:00 08/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [17:30:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:30:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:30:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:30:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:30:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 81 u1: BPM st: NotStopd t0: [17:30:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 172 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [17:30:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 116 u1: mmHg st: NotStopd t0: [17:30:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:30:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [17:30:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [17:30:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:30:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [18:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 08/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [18:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 08/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [18:00:00 08/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [18:00:00 08/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [18:00:00 08/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 08/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [18:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [18:00:00 08/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 08/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [18:00:00 08/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 08/02/2016] id: Previous Weight el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [18:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [18:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [18:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [18:00:00 08/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [18:00:00 08/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [18:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.75 vu: ml t0: [18:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [17:30:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [18:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:00:00 08/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 152 rs: Manual st: NotStopd
t0: [18:27:00 08/02/2016] id: Lactic Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [18:27:00 08/02/2016] id: Lactic Acid(0.5-2.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [18:27:00 08/02/2016] id: Venous CO2(Calc) VBG'S el: 0 cu: MICU cg: 1663 v1: no data rs: Final st: NotStopd t0: [18:27:00 08/02/2016] id: Venous PvCO2 VBG's el: 0 cu: MICU cg: 1663 u1: mmHg rs: Final st: NotStopd t0: [18:27:00 08/02/2016] id: Venous PvO2 Mixed Venous Gases el: 0 cu: MICU cg: 1663 u1: mmHg rs: Final st: NotStopd t0: [18:27:00 08/02/2016] id: Venous pH VBG's el: 0 cu: MICU cg: 1663 v1: 7.41 u1: pH rs: Final st: NotStopd
t0: [18:31:00 08/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 97 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 116 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 97 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 116 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.9 rs: Final st: NotStopd t0: [18:31:00 08/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
t0: [20:00:00 08/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 08/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15.7895 u1: ml/cmH st: NotStopd t0: [20:00:00 08/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 08/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 08/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 08/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [20:00:00 08/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [20:00:00 08/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 08/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 08/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 08/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 08/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 08/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 08/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 08/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [20:00:00 08/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.8 u1: L/min st: NotStopd t0: [20:00:00 08/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 08/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 08/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [20:00:00 08/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [20:00:00 08/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [20:00:00 08/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [20:00:00 08/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 08/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:00:00 08/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 08/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 08/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 313 u1: ml/B st: NotStopd t0: [20:00:00 08/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 08/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 08/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 08/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 08/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 08/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:00:00 08/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 08/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [19:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [19:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [19:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [19:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 08/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 08/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [20:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 08/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 08/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 08/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 08/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 08/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 08/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 08/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 08/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 08/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [20:00:00 08/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 08/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 08/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [20:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 08/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 08/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 08/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 08/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 08/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 08/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 08/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 08/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 08/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 08/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 08/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [20:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78.3333 u1: mmHg st: NotStopd t0: [20:00:00 08/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 08/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 08/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 08/02/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 08/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [20:00:00 08/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 08/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 08/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [20:00:00 08/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 08/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 08/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 08/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 08/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 08/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 08/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [20:00:00 08/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 08/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 08/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 08/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 08/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 08/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 08/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [20:00:00 08/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 08/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 08/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 08/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 08/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 08/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [20:00:00 08/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [19:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [19:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [19:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [20:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [20:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [21:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Sedated st: NotStopd t0: [21:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [21:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [21:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 80.6667 u1: mmHg st: NotStopd t0: [21:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [21:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [21:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [21:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [22:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [22:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [22:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [22:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [22:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [22:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:30:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:30:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:30:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:30:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [22:30:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [22:30:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [22:30:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:30:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [22:30:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [22:30:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:30:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [22:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [19:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:30:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 08/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 290 ap: none
t0: [22:00:00 08/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [22:00:00 08/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [22:00:00 08/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [23:00:00 08/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 08/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 08/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [23:00:00 08/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 08/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 08/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 08/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [23:00:00 08/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 08/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 08/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [23:00:00 08/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [23:00:00 08/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 08/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 08/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 08/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.75 vu: ml t0: [23:00:00 08/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 08/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 08/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 350 cv: 350 ap: none t0: [23:00:00 08/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -263.25 cv: -263.25 ap: none t0: [23:00:00 08/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 11.75 cv: 524.5 ap: none t0: [23:00:00 08/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 86.75 cv: 2614.5 ap: none t0: [23:00:00 08/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1800 ap: none t0: [23:00:00 08/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 350 cv: 2710 ap: none t0: [23:00:00 08/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -263.25 cv: -695.5 ap: none t0: [23:00:00 08/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 350 cv: 3310 ap: none t0: [23:00:00 08/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -263.25 cv: 7666.04 ap: carryForward
t0: [00:00:00 09/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 09/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15.7895 u1: ml/cmH st: NotStopd t0: [00:00:00 09/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 09/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 09/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 09/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [00:00:00 09/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [00:00:00 09/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 09/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 09/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [00:00:00 09/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 09/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 09/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 09/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 09/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [00:00:00 09/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.7 u1: L/min st: NotStopd t0: [00:00:00 09/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 09/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 09/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [00:00:00 09/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [00:00:00 09/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [00:00:00 09/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [00:00:00 09/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 09/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 09/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 09/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 09/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 305 u1: ml/B st: NotStopd t0: [00:00:00 09/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 09/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 09/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 09/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 09/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 09/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 09/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 09/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [23:00:00 08/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [23:00:00 08/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.6667 u1: mmHg st: NotStopd t0: [00:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [00:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [00:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [00:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.5 vu: ml t0: [00:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [00:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 08/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [22:00:00 08/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 08/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 08/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 08/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [22:00:00 08/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 08/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [22:00:00 08/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 09/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 09/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 09/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [00:00:00 09/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [00:00:00 09/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [00:00:00 09/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 09/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [00:00:00 09/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 09/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 09/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 09/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 09/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 09/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 09/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 09/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 09/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 09/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 09/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [00:00:00 09/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 09/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 09/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 09/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 09/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 09/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [00:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77.6667 u1: mmHg st: NotStopd t0: [00:00:00 09/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 09/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 09/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [00:00:00 09/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 09/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 09/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 09/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 09/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 09/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 09/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 09/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 09/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 09/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [00:00:00 09/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 09/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 09/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 09/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 09/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 09/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 09/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [00:00:00 09/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 09/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 09/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 09/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 09/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [00:00:00 09/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [00:00:00 09/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [01:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [01:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [01:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [01:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [01:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [01:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [01:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.5 vu: ml t0: [01:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 09/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 80 cv: 80 ap: none t0: [23:00:00 09/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 80 cv: 2270 ap: none t0: [23:00:00 09/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 80 cv: 3020 ap: none
t0: [02:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 09/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [02:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [02:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 09/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [02:00:00 09/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [02:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [02:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [02:00:00 09/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [02:00:00 09/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [02:00:00 09/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [02:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [02:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [02:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 09/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [02:00:00 09/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [02:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.5 vu: ml t0: [02:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [02:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [03:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 88 u1: BPM st: NotStopd t0: [03:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 48 u2: mmHg st: NotStopd t0: [03:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 65.3333 u1: mmHg st: NotStopd t0: [03:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [03:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [03:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 09/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [03:00:00 09/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.7222 u1: Deg. C st: NotStopd t0: [03:00:00 09/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.9 u1: Deg. F st: NotStopd t0: [03:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.5 vu: ml t0: [03:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [03:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 09/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -8 cv: -8 ap: none t0: [23:00:00 09/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 12 cv: 566.25 ap: none t0: [23:00:00 09/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 72 cv: 3043.75 ap: none t0: [23:00:00 09/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1627.5 ap: none t0: [23:00:00 09/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -8 cv: 23.75 ap: none t0: [23:00:00 09/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -8 cv: 7689.79 ap: carryForward
t0: [04:00:00 09/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 09/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 13.6364 u1: ml/cmH st: NotStopd t0: [04:00:00 09/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: Positional st: NotStopd t0: [04:00:00 09/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 09/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 09/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [04:00:00 09/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.3 st: NotStopd t0: [04:00:00 09/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 09/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 09/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [04:00:00 09/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 09/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 09/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 09/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 09/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [04:00:00 09/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.3 u1: L/min st: NotStopd t0: [04:00:00 09/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 09/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 09/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [04:00:00 09/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [04:00:00 09/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 11.8 u1: BPM st: NotStopd t0: [04:00:00 09/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 09/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 09/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 09/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [04:00:00 09/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 334 u1: ml/B st: NotStopd t0: [04:00:00 09/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 09/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 09/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 09/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 09/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 09/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:00:00 09/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 09/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 09/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 09/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [04:00:00 09/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [04:00:00 09/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 09/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 09/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 85 u1: BPM st: NotStopd t0: [04:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 09/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 09/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 09/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 09/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 09/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 09/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [04:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [04:00:00 09/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 09/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [04:00:00 09/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 09/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 09/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [04:00:00 09/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 09/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 09/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 82 u1: BPM st: NotStopd t0: [05:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [05:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [05:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.5 vu: ml t0: [04:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [05:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.5 vu: ml t0: [05:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [04:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:00:00 09/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 09/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [04:00:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 09/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 09/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Headache st: NotStopd t0: [04:00:00 09/02/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: Aching st: NotStopd
t0: [04:00:00 09/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd
t0: [05:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 90 u1: mmHg v2: 40 u2: mmHg st: NotStopd t0: [05:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 56.6667 u1: mmHg st: NotStopd t0: [06:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [06:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 93 u1: mmHg v2: 44 u2: mmHg st: NotStopd t0: [06:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 60.3333 u1: mmHg st: NotStopd t0: [06:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [06:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [06:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 09/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 09/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 09/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [05:00:00 09/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 09/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [05:00:00 09/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [05:00:00 09/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [05:00:00 09/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [06:00:00 09/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [06:00:00 09/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [06:00:00 09/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [06:00:00 09/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd
t0: [06:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [06:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [05:30:00 09/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.5 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 8.5 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 22.6 u1: % rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 7 u1: gm/dl rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 778 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.5 u1: /mic l rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.5 rs: Final st: NotStopd
t0: [05:30:00 09/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 14.3 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 31.3 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14.3 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 31.3 rs: Final st: NotStopd
t0: [05:30:00 09/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 97 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.4 u1: mEq/L rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.1 u1: mg/dl rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 34 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 97 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 108 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.4 u1: mEq/L rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [05:30:00 09/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
t0: [06:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 5 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:30:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:30:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:30:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:30:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:30:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:30:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [06:30:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:30:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 90 u1: mmHg v2: 38 u2: mmHg st: NotStopd t0: [06:30:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 55.3333 u1: mmHg st: NotStopd t0: [06:30:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:30:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [06:30:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [06:30:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:30:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:30:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 2 du: mghr sv: 50 su: ml rt: IV Drip
tf: [07:00:00 10/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 8 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [08:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [08:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [08:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 64 u1: mmHg st: NotStopd t0: [08:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [08:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2.75 vu: ml t0: [08:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [08:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 09/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: SRT v1: 1 v2: 23 st: NotStopd t0: [08:00:00 09/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: SRT v1: 12.5 u1: ml/cmH st: NotStopd t0: [08:00:00 09/02/2016] id: Cuff Leak el: 0 cu: MICU cg: SRT v1: Positional st: NotStopd t0: [08:00:00 09/02/2016] id: FiO2 Set el: 0 cu: MICU cg: SRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 09/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: SRT v1: 45 u1: cmH2O st: NotStopd t0: [08:00:00 09/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: SRT v1: 35 u1: BPM st: NotStopd t0: [08:00:00 09/02/2016] id: I:E Ratio el: 0 cu: MICU cg: SRT v1: 1:2.5 st: NotStopd t0: [08:00:00 09/02/2016] id: Airway Size el: 0 cu: MICU cg: SRT v1: 8.0 mm st: NotStopd t0: [08:00:00 09/02/2016] id: Airway Type el: 0 cu: MICU cg: SRT v1: Tracheostomy st: NotStopd t0: [08:00:00 09/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: SRT v1: 35.2 u1: Deg. C st: NotStopd t0: [08:00:00 09/02/2016] id: Intubation Date el: 0 cu: MICU cg: SRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 09/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: SRT v1: 4 st: NotStopd t0: [08:00:00 09/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: SRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 09/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: SRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 09/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: SRT v1: 15 u1: cmH2O st: NotStopd t0: [08:00:00 09/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: SRT v1: 10.5 u1: L/min st: NotStopd t0: [08:00:00 09/02/2016] id: PEEP Set el: 0 cu: MICU cg: SRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 09/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: SRT v1: 20 st: NotStopd t0: [08:00:00 09/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: SRT v1: 29 u1: cmH2O st: NotStopd t0: [08:00:00 09/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: SRT v1: 24 u1: cmH2O st: NotStopd t0: [08:00:00 09/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: SRT v1: 5 u1: BPM st: NotStopd t0: [08:00:00 09/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: SRT v1: 25 u1: BPM st: NotStopd t0: [08:00:00 09/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: SRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 09/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: SRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 09/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: SRT v2: None st: NotStopd t0: [08:00:00 09/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: SRT v1: 301 u1: ml/B st: NotStopd t0: [08:00:00 09/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: SRT v1: 300 u1: ml/B st: NotStopd t0: [08:00:00 09/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: SRT v1: Yes v2: No st: NotStopd t0: [08:00:00 09/02/2016] id: Trach Size el: 0 cu: MICU cg: SRT v1: #8 st: NotStopd t0: [08:00:00 09/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: SRT v1: Inflated st: NotStopd t0: [08:00:00 09/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: SRT v1: Portex st: NotStopd t0: [08:00:00 09/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: SRT v1: Assist Control st: NotStopd t0: [08:00:00 09/02/2016] id: Ventilator Type el: 0 cu: MICU cg: SRT v1: Drager st: NotStopd t0: [08:00:00 09/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: SRT v1: RAMP st: NotStopd
t0: [09:00:00 09/02/2016] id: .9% Normal Saline 1000.0ml IV Infusions el: 2 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd
t0: [09:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 09/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [09:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 09/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [09:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 09/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [09:00:00 09/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 09/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [09:00:00 09/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [09:00:00 09/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [09:00:00 09/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [09:00:00 09/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [09:00:00 09/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [09:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [09:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 09/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [09:00:00 09/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [09:00:00 09/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [09:00:00 09/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [09:00:00 09/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [09:00:00 09/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 09/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 09/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [09:00:00 09/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [09:00:00 09/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [09:00:00 09/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 09/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 09/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [09:00:00 09/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [09:00:00 09/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 09/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [09:00:00 09/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [09:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 50 u2: mmHg st: NotStopd t0: [09:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 66.6667 u1: mmHg st: NotStopd t0: [09:00:00 09/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [09:00:00 09/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [09:00:00 09/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 09/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 09/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 09/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [09:00:00 09/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [09:00:00 09/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [09:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [09:00:00 09/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [09:00:00 09/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 09/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 09/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [09:00:00 09/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [09:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 09/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [09:00:00 09/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [09:00:00 09/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 09/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [09:00:00 09/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6111 u1: Deg. C st: NotStopd t0: [09:00:00 09/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.7 u1: Deg. F st: NotStopd t0: [09:00:00 09/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [09:00:00 09/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [09:00:00 09/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [09:00:00 09/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [09:00:00 09/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [09:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 09/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [09:00:00 09/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [09:00:00 09/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [09:00:00 09/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [09:00:00 09/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [09:00:00 09/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [09:00:00 09/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [09:00:00 09/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [09:00:00 09/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [09:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 0 vu: ml t0: [09:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [09:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 50 su: ml rt: IV Drip
tf: [12:00:00 10/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Warfarin v1: 2.5 u1: mg
t0: [10:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 79 u1: BPM st: NotStopd t0: [10:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [10:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 72.6667 u1: mmHg st: NotStopd t0: [10:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [10:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [10:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 09/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [10:00:00 09/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [10:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml
t0: [11:45:00 09/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: SRT v1: 1 v2: 23 st: NotStopd t0: [11:45:00 09/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: SRT v1: 11.5385 u1: ml/cmH st: NotStopd t0: [11:45:00 09/02/2016] id: Cuff Leak el: 0 cu: MICU cg: SRT v1: Positional st: NotStopd t0: [11:45:00 09/02/2016] id: FiO2 Set el: 0 cu: MICU cg: SRT v1: 0.4 u1: torr st: NotStopd t0: [11:45:00 09/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: SRT v1: 45 u1: cmH2O st: NotStopd t0: [11:45:00 09/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: SRT v1: 35 u1: BPM st: NotStopd t0: [11:45:00 09/02/2016] id: I:E Ratio el: 0 cu: MICU cg: SRT v1: 1:2.5 st: NotStopd t0: [11:45:00 09/02/2016] id: Airway Size el: 0 cu: MICU cg: SRT v1: 8.0 mm st: NotStopd t0: [11:45:00 09/02/2016] id: Airway Type el: 0 cu: MICU cg: SRT v1: Tracheostomy st: NotStopd t0: [11:45:00 09/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: SRT v1: 35.2 u1: Deg. C st: NotStopd t0: [11:45:00 09/02/2016] id: Intubation Date el: 0 cu: MICU cg: SRT v1: 12 v2: 23 st: NotStopd t0: [11:45:00 09/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: SRT v1: 4 st: NotStopd t0: [11:45:00 09/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: SRT v1: 6 v2: Albuterol st: NotStopd t0: [11:45:00 09/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: SRT v1: 6 v2: Atrovent st: NotStopd t0: [11:45:00 09/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: SRT v1: 16 u1: cmH2O st: NotStopd t0: [11:45:00 09/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: SRT v1: 10.7 u1: L/min st: NotStopd t0: [11:45:00 09/02/2016] id: PEEP Set el: 0 cu: MICU cg: SRT v1: 5 u1: cmH2O st: NotStopd t0: [11:45:00 09/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: SRT v1: 20 st: NotStopd t0: [11:45:00 09/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: SRT v1: 31 u1: cmH2O st: NotStopd t0: [11:45:00 09/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: SRT v1: 29 u1: cmH2O st: NotStopd t0: [11:45:00 09/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: SRT v1: 17 u1: BPM st: NotStopd t0: [11:45:00 09/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: SRT v1: 37 u1: BPM st: NotStopd t0: [11:45:00 09/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: SRT v1: 20 u1: BPM st: NotStopd t0: [11:45:00 09/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: SRT v1: 3 u1: cmH2O st: NotStopd t0: [11:45:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: SRT v1: 100 u1: % st: NotStopd t0: [11:45:00 09/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: SRT v1: Tan v2: Thin st: NotStopd t0: [11:45:00 09/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: SRT v1: Suctioned v2: Small st: NotStopd t0: [11:45:00 09/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: SRT v1: 0.295 u1: ml/B st: NotStopd t0: [11:45:00 09/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: SRT v1: 300 u1: ml/B st: NotStopd t0: [11:45:00 09/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: SRT v1: Yes v2: No st: NotStopd t0: [11:45:00 09/02/2016] id: Trach Size el: 0 cu: MICU cg: SRT v1: #8 st: NotStopd t0: [11:45:00 09/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: SRT v1: Portex st: NotStopd t0: [11:45:00 09/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: SRT v1: Assist Control st: NotStopd t0: [11:45:00 09/02/2016] id: Ventilator Type el: 0 cu: MICU cg: SRT v1: Drager st: NotStopd t0: [11:45:00 09/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: SRT v1: RAMP st: NotStopd
tf: [09:00:00 11/02/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Furosemide v1: 40 u1: mg m2: D5W v2: 50 u2: ml
t0: [12:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 09/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 09/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 09/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 09/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [12:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 09/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 09/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 09/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [12:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [12:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 09/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [12:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [12:00:00 09/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 09/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 09/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 09/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 09/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [12:00:00 09/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [12:00:00 09/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [12:00:00 09/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 09/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 142 rs: Manual st: NotStopd
t0: [12:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [12:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [13:14:00 09/02/2016] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [13:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [13:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [13:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 80.6667 u1: mmHg st: NotStopd t0: [13:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [13:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [13:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [14:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 09/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [14:00:00 09/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [14:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 09/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [14:00:00 09/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [14:00:00 09/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [14:00:00 09/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [14:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [14:00:00 09/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 09/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [14:00:00 09/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [14:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 09/02/2016] id: Previous Weight el: 0 cu: MICU cg: RN v1: 55.8 u1: kg st: NotStopd t0: [14:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [14:00:00 09/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 09/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [14:00:00 09/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [14:00:00 09/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd t0: [14:00:00 09/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [14:00:00 09/02/2016] id: BSA - English el: 0 cu: MICU cg: RN v1: 0.997878 u1: m2 st: NotStopd t0: [14:00:00 09/02/2016] id: BSA - Metric el: 0 cu: MICU cg: RN v1: 1.17018 u1: m2 st: NotStopd t0: [14:00:00 09/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 09/02/2016] id: Weight Change el: 0 cu: MICU cg: RN v1: -0.8 u1: kg st: NotStopd t0: [14:00:00 09/02/2016] id: Daily Weight el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd
t0: [14:00:00 09/02/2016] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 0 vu: ml nb: 1 t0: [14:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [14:00:00 09/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 120 vu: ml t0: [14:30:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [14:30:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 37.5 vu: ml
t0: [15:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [15:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [15:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [15:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [15:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [15:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 0 vu: ml t0: [15:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml
t0: [15:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:40:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:40:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:40:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:40:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:40:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:40:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [15:40:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:40:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [15:40:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [15:40:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:40:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [15:40:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [15:40:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:40:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:40:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:40:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 6.66667 vu: ml t0: [15:40:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1 vu: ml st: Stopped t0: [15:40:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [16:30:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:30:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:30:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:30:00 09/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:30:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:30:00 09/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:30:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:30:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:30:00 09/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:30:00 09/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:30:00 09/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:30:00 09/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:30:00 09/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:30:00 09/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:30:00 09/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:30:00 09/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:30:00 09/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:30:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [16:30:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:30:00 09/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:30:00 09/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:30:00 09/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:30:00 09/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:30:00 09/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:30:00 09/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [16:30:00 09/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:30:00 09/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Wound Cleanser st: NotStopd t0: [16:30:00 09/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:30:00 09/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:30:00 09/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:30:00 09/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [16:30:00 09/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:30:00 09/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:30:00 09/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:30:00 09/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:30:00 09/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:30:00 09/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:30:00 09/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:30:00 09/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:30:00 09/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:30:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [16:30:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.6667 u1: mmHg st: NotStopd t0: [16:30:00 09/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:30:00 09/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:30:00 09/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:30:00 09/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [16:30:00 09/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [16:30:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:30:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [16:30:00 09/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:30:00 09/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:30:00 09/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:30:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [16:30:00 09/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:30:00 09/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:30:00 09/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:30:00 09/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:30:00 09/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:30:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:30:00 09/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:30:00 09/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [16:30:00 09/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:30:00 09/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:30:00 09/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:30:00 09/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [16:30:00 09/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [16:30:00 09/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [16:30:00 09/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:30:00 09/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:30:00 09/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:30:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:30:00 09/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [16:30:00 09/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:30:00 09/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [16:30:00 09/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [16:30:00 09/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:30:00 09/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [16:30:00 09/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [16:30:00 09/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [16:30:00 09/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [16:30:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 8.33333 vu: ml t0: [16:30:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 50 vu: ml
t0: [16:30:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 0 du: mghr sv: 50 su: ml rt: IV Drip
t0: [17:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 09/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [17:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [17:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 09/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [17:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [17:00:00 09/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 09/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [17:00:00 09/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [17:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [17:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 09/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [17:00:00 09/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [17:00:00 09/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [17:00:00 09/02/2016] id: Trach Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 09/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [17:00:00 09/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 0 vu: ml st: Restart t0: [17:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml
t0: [17:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 3 du: mghr sv: 50 su: ml rt: IV Drip
t0: [17:00:00 09/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [17:00:00 09/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15 u1: ml/cmH st: NotStopd t0: [17:00:00 09/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [17:00:00 09/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 09/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [17:00:00 09/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [17:00:00 09/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.5 st: NotStopd t0: [17:00:00 09/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [17:00:00 09/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [17:00:00 09/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 09/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 09/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [17:00:00 09/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 09/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:00:00 09/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [17:00:00 09/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.54 u1: L/min st: NotStopd t0: [17:00:00 09/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 09/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 09/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [17:00:00 09/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [17:00:00 09/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [17:00:00 09/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [17:00:00 09/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [17:00:00 09/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [17:00:00 09/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [17:00:00 09/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [17:00:00 09/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [17:00:00 09/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [17:00:00 09/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [17:00:00 09/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [17:00:00 09/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [17:00:00 09/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [18:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [18:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 124 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [18:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [18:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [18:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [18:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [18:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 09/02/2016] tf: [17:24:00 26/02/2016] dt: 24444 id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 1.5 vu: ml t0: [18:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [23:00:00 09/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 750 ap: none
t0: [18:00:00 09/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 119 rs: Manual st: NotStopd
t0: [18:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:30:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:30:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:30:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [18:30:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:30:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [18:30:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.3333 u1: mmHg st: NotStopd t0: [18:30:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:30:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [18:30:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [18:30:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:30:00 09/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [18:30:00 09/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [18:30:00 09/02/2016] id: Trach Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:30:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 09/02/2016] tf: [08:00:00 14/02/2016] dt: 6600 id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 375 vu: ml
t0: [18:30:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 09/02/2016] dt: 24 id: Blood Products Total el: 2 cu: MICU cg: RN cv: 375 ap: none
t0: [19:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [19:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [19:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 39 u1: BPM st: NotStopd t0: [19:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 09/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 09/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 09/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 09/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 09/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 09/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [20:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 09/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 09/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 09/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 09/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 09/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 09/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [20:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [20:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [20:00:00 09/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 09/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [20:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [20:00:00 09/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [20:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 09/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [20:00:00 09/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [20:00:00 09/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 09/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 09/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [20:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [20:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [19:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [20:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:43:00 09/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:43:00 09/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 11.5385 u1: ml/cmH st: NotStopd t0: [20:43:00 09/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:43:00 09/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:43:00 09/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:43:00 09/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:43:00 09/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.5 st: NotStopd t0: [20:43:00 09/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:43:00 09/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:43:00 09/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:43:00 09/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:43:00 09/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:43:00 09/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:43:00 09/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:43:00 09/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [20:43:00 09/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.85 u1: L/min st: NotStopd t0: [20:43:00 09/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:43:00 09/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:43:00 09/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [20:43:00 09/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [20:43:00 09/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [20:43:00 09/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [20:43:00 09/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:43:00 09/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:43:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:43:00 09/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:43:00 09/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:43:00 09/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:43:00 09/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:43:00 09/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:43:00 09/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:43:00 09/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:43:00 09/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [21:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 09/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [21:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 09/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [21:00:00 09/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [21:00:00 09/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [21:00:00 09/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [21:00:00 09/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [21:00:00 09/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [21:00:00 09/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [21:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 09/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 09/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 09/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 09/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [21:00:00 09/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [21:00:00 09/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 09/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 09/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [21:00:00 09/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [21:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.6667 u1: mmHg st: NotStopd t0: [21:00:00 09/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [21:00:00 09/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 09/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 09/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 09/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [21:00:00 09/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 09/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [21:00:00 09/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [21:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [21:00:00 09/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [21:00:00 09/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 09/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 09/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [21:00:00 09/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [21:00:00 09/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [21:00:00 09/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 09/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 09/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd
t0: [21:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [21:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [21:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [21:00:00 09/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [21:00:00 09/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [21:00:00 09/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd
t0: [20:00:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 09/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 09/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [21:00:00 09/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [22:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [22:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [22:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.3333 u1: mmHg st: NotStopd t0: [22:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [22:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [22:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 09/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 50 vu: ml t0: [22:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [22:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [22:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 09/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 475 ap: none
t0: [22:00:00 09/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [22:00:00 09/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd
t0: [23:00:00 09/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 09/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 09/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 09/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 09/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 09/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [23:00:00 09/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 09/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [23:00:00 09/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [23:00:00 09/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [23:00:00 09/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [23:00:00 09/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 09/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 09/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 09/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [23:00:00 09/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [23:00:00 09/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 10/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 10/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 13.0435 u1: ml/cmH st: NotStopd t0: [00:00:00 10/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 10/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 10/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 10/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [00:00:00 10/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.5 st: NotStopd t0: [00:00:00 10/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 10/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 10/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [00:00:00 10/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 10/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 10/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 10/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 10/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 10/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.73 u1: L/min st: NotStopd t0: [00:00:00 10/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 10/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 10/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [00:00:00 10/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [00:00:00 10/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [00:00:00 10/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [00:00:00 10/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 10/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 10/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thin st: NotStopd t0: [00:00:00 10/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [00:00:00 10/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 325 u1: ml/B st: NotStopd t0: [00:00:00 10/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 10/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 10/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 10/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 10/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 10/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [00:00:00 10/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 10/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [00:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [00:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.6667 u1: mmHg st: NotStopd t0: [00:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [00:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [00:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [00:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [00:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [01:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [01:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [01:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.3333 u1: mmHg st: NotStopd t0: [01:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [01:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [01:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [01:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [01:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [02:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 159 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [02:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 111.667 u1: mmHg st: NotStopd t0: [02:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [02:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [02:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 10/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [02:00:00 10/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [02:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [02:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [02:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 10/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 115 cv: 115 ap: none t0: [23:00:00 10/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -27 cv: -27 ap: none t0: [23:00:00 10/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 13 cv: 545 ap: none t0: [23:00:00 10/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 88 cv: 2935 ap: none t0: [23:00:00 10/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1725 ap: none t0: [23:00:00 10/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 115 cv: 2395 ap: none t0: [23:00:00 10/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -27 cv: -160 ap: none t0: [23:00:00 10/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 115 cv: 3095 ap: none t0: [23:00:00 10/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -27 cv: 7529.79 ap: carryForward
t0: [03:40:00 10/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 11.5385 u1: ml/cmH st: NotStopd t0: [03:40:00 10/02/2016] id: RSBI (<100) el: 0 cu: MICU cg: RRT u1: units st: NotStopd t0: [03:40:00 10/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [03:40:00 10/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [03:40:00 10/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [03:40:00 10/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.5 st: NotStopd t0: [03:40:00 10/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [03:40:00 10/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [03:40:00 10/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [03:40:00 10/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [03:40:00 10/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [03:40:00 10/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [03:40:00 10/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [03:40:00 10/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [03:40:00 10/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [03:40:00 10/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [03:40:00 10/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [03:40:00 10/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 31 u1: cmH2O st: NotStopd t0: [03:40:00 10/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [03:40:00 10/02/2016] id: RSBI (<200) el: 0 cu: MICU cg: RRT u1: units st: NotStopd t0: [03:40:00 10/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [03:40:00 10/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [03:40:00 10/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [03:40:00 10/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [03:40:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [03:40:00 10/02/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 43 u1: BPM st: NotStopd t0: [03:40:00 10/02/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.102 u1: L st: NotStopd t0: [03:40:00 10/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [03:40:00 10/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [03:40:00 10/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 295 u1: ml/B st: NotStopd t0: [03:40:00 10/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [03:40:00 10/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [03:40:00 10/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [03:40:00 10/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [03:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [03:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [03:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [03:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [03:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [03:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [04:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [04:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.6667 u1: mmHg st: NotStopd t0: [04:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [04:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [04:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [03:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [04:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [04:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [03:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [05:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [05:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [05:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [05:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [05:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [05:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [05:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [05:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 09/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 09/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 10/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 10/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 10/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 10/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 10/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 10/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 10/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 10/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 10/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 10/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 10/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 10/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 10/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 10/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 10/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 10/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [00:00:00 10/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 10/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 10/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 10/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 10/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 10/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 10/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3889 u1: Deg. C st: NotStopd t0: [00:00:00 10/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.3 u1: Deg. F st: NotStopd t0: [00:00:00 10/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 10/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 10/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 10/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 10/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 114 rs: Manual st: NotStopd t0: [00:00:00 10/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 10/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 10/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 10/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [00:00:00 10/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 10/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [00:00:00 10/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [04:00:00 10/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 10/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 10/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 10/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 10/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 10/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 10/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 10/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 10/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 10/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 10/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 10/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 10/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 10/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 10/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 10/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 10/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 10/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 10/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 10/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 10/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 10/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 10/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 10/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 10/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 10/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 10/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 10/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 10/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 10/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 10/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 10/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 10/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 10/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 10/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 10/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 10/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [04:00:00 10/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [04:00:00 10/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [04:00:00 10/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 10/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 10/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 10/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 10/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done t0: [04:00:00 10/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 10/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [06:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [06:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [05:00:00 10/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.2 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 7.2 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 25.3 u1: % rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8 u1: gm/dl rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 766 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 2.86 u1: /mic l rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 7.2 rs: Final st: NotStopd
t0: [06:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [06:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [06:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.6667 u1: mmHg st: NotStopd t0: [06:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [06:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [05:00:00 10/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.3 u1: mg/dl rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 94 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 u1: mEq/L rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.3 u1: mg/dl rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 34 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 94 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 u1: mEq/L rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.7 rs: Final st: NotStopd t0: [05:00:00 10/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
t0: [08:00:00 10/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:00:00 10/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 14.2857 u1: ml/cmH st: NotStopd t0: [08:00:00 10/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 10/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 10/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [08:00:00 10/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [08:00:00 10/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.5 st: NotStopd t0: [08:00:00 10/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 10/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 10/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [08:00:00 10/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 10/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 10/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 10/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 10/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 17 u1: cmH2O st: NotStopd t0: [08:00:00 10/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.6 u1: L/min st: NotStopd t0: [08:00:00 10/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 10/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 10/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [08:00:00 10/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [08:00:00 10/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [08:00:00 10/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [08:00:00 10/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 10/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 10/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 280 u1: ml/B st: NotStopd t0: [08:00:00 10/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:00:00 10/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 10/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 10/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 10/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 10/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 10/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 10/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 10/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 10/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 10/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 10/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 10/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 10/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 10/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 10/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 10/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 10/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [08:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 10/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 10/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 10/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 10/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 10/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 10/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 10/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 10/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 10/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [08:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [08:00:00 10/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 10/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:00:00 10/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [08:00:00 10/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 10/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 10/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [08:00:00 10/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 10/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 10/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 10/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 10/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [08:00:00 10/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [08:00:00 10/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 10/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 10/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 10/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [07:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [07:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [07:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [08:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [08:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [08:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [09:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [09:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [09:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.6667 u1: mmHg st: NotStopd t0: [09:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [09:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [09:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [09:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [09:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
tf: [09:00:00 11/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Warfarin v1: 1 u1: mg
t0: [10:00:00 10/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [10:00:00 10/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.2 u1: L/min st: NotStopd t0: [10:00:00 10/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [10:00:00 10/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 46 u1: BPM st: NotStopd t0: [10:00:00 10/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 162 u1: ml/B st: NotStopd t0: [10:00:00 10/02/2016] id: Total PEEP Level el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [10:00:00 10/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd
t0: [10:11:00 10/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [10:11:00 10/02/2016] id: Total PEEP Level el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd
t0: [10:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [10:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [10:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85 u1: mmHg st: NotStopd t0: [10:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [10:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [10:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 10/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 60 vu: ml t0: [10:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [10:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [10:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:00:00 10/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [10:00:00 10/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.9 u1: Deg. F st: NotStopd
t0: [10:30:00 10/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [10:30:00 10/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 4 t0: [10:30:00 10/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 4 t0: [10:30:00 10/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 30 t0: [10:30:00 10/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd
t0: [08:00:00 10/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 10/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 10/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 10/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 10/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 10/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 10/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 10/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 10/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [08:00:00 10/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [10:00:00 10/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [11:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 10/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [11:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [11:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 10/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [11:00:00 10/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [11:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 107.333 u1: mmHg st: NotStopd t0: [11:00:00 10/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [11:00:00 10/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [11:00:00 10/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [11:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [11:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 10/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [11:00:00 10/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [11:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [11:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [11:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:15:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:15:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:15:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:15:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:15:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:15:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [11:15:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:15:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [11:15:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [11:15:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:15:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [11:15:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [11:15:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:15:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:15:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 10/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 10/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 10/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 10/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 10/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 10/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 10/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 10/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 10/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 10/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 10/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 10/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 10/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 10/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 10/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 10/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [08:00:00 10/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [11:40:00 10/02/2016] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [12:00:00 10/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:00:00 10/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 10/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [12:00:00 10/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 3 t0: [12:00:00 10/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 4 t0: [12:00:00 10/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 10/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 30 t0: [12:00:00 10/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [12:00:00 10/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [12:00:00 10/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:1.3 st: NotStopd t0: [12:00:00 10/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 10/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 10/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [12:00:00 10/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 10/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 10/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 10/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 10/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.1 u1: L/min st: NotStopd t0: [12:00:00 10/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 10/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [12:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:00:00 10/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 203 u1: ml/B st: NotStopd t0: [12:00:00 10/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 10/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:00:00 10/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:00:00 10/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:00:00 10/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [12:00:00 10/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [12:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [12:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [12:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [12:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [12:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [12:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [12:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [12:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 10/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 10/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 10/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 10/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 10/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [12:00:00 10/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [12:00:00 10/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 10/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 10/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [12:00:00 10/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 10/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 10/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 10/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 10/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 10/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 10/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 10/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 10/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 10/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 10/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 10/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 10/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 10/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 10/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [12:00:00 10/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Strong/Palpable st: NotStopd t0: [12:00:00 10/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 10/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 10/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 10/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 10/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 10/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 10/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 10/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 10/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 10/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 10/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 10/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 10/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [12:00:00 10/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 10/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [10:15:00 10/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 16.2 rs: Final st: NotStopd t0: [10:15:00 10/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [10:15:00 10/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [10:15:00 10/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 16.2 rs: Final st: NotStopd
t0: [12:00:00 10/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: RN v1: 130 rs: Manual st: NotStopd t0: [12:00:00 10/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: RN v1: 130 rs: Manual st: NotStopd
t0: [13:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [13:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [13:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.6667 u1: mmHg st: NotStopd t0: [13:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [13:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [13:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 10/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [13:00:00 10/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [13:00:00 10/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [13:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 10/02/2016] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: -1 vu: ml nb: 1 t0: [13:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [13:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [13:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [14:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [14:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [14:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [14:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [14:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [14:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [14:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [14:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [14:00:00 10/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [14:00:00 10/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 10/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [14:00:00 10/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [14:00:00 10/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [14:00:00 10/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [14:00:00 10/02/2016] id: Trach Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [15:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [15:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [15:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [15:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [15:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [15:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 4 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [16:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [16:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.3333 u1: mmHg st: NotStopd t0: [16:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [16:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 2 vu: ml t0: [16:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [16:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN u1: kg st: NotStopd t0: [09:00:00 09/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN u1: kg st: NotStopd
t0: [16:00:00 10/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:00:00 10/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:00:00 10/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [16:00:00 10/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 3 t0: [16:00:00 10/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 4 t0: [16:00:00 10/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 10/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 30 t0: [16:00:00 10/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [16:00:00 10/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [16:00:00 10/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:1.3 st: NotStopd t0: [16:00:00 10/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 10/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 10/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 10/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 10/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 10/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 10/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 10/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [16:00:00 10/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 6.8 u1: L/min st: NotStopd t0: [16:00:00 10/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:00:00 10/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 10/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 47 u1: BPM st: NotStopd t0: [16:00:00 10/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 270 u1: ml/B st: NotStopd t0: [16:00:00 10/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:00:00 10/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:00:00 10/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:00:00 10/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:00:00 10/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [16:00:00 10/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [15:00:00 10/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [15:00:00 10/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [15:00:00 10/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [16:00:00 10/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 10/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 10/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 10/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 10/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 10/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 10/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 10/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 10/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 10/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 10/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 10/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 10/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 10/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 10/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 10/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 10/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 10/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 10/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 10/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 10/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 10/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 10/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 10/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 10/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 10/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 10/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 10/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 10/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 10/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 10/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 10/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 10/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 10/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 10/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 10/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 10/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 10/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 10/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 10/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 10/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 10/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 10/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 10/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [16:00:00 10/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [16:00:00 10/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 10/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 10/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 10/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [16:00:00 10/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 10/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 10/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 10/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 10/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 10/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 10/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [17:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [17:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [17:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100.667 u1: mmHg st: NotStopd t0: [17:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [17:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [17:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 10/02/2016] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: -1 vo: 375 vu: ml t0: [17:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [17:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [17:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 10/02/2016] dt: 24 id: Blood Products Total el: 2 cu: MICU cg: RN cv: 375 ap: none
t0: [18:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [18:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [18:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.3333 u1: mmHg st: NotStopd t0: [18:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [18:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [18:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [18:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [18:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 10/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 700 ap: none
t0: [17:00:00 10/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [17:00:00 10/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [17:00:00 10/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 10/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [17:00:00 10/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 10/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 10/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [17:30:00 10/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:30:00 10/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.8 st: NotStopd t0: [17:30:00 10/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [17:30:00 10/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.3 u1: L/min st: NotStopd t0: [17:30:00 10/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [17:30:00 10/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [17:30:00 10/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [17:30:00 10/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [17:30:00 10/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [17:30:00 10/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [17:30:00 10/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [17:30:00 10/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [17:30:00 10/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [19:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [19:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [19:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [19:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [19:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [19:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [19:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [19:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [19:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [19:00:00 10/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [19:00:00 10/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 10/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [19:00:00 10/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [19:00:00 10/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [19:00:00 10/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [19:00:00 10/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [19:00:00 10/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [19:00:00 10/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [19:00:00 10/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [19:00:00 10/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 10/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [19:00:00 10/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [19:00:00 10/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 10/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [19:00:00 10/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [19:00:00 10/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [19:00:00 10/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd
t0: [20:17:00 10/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:17:00 10/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12.5 u1: ml/cmH st: NotStopd t0: [20:17:00 10/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:17:00 10/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:17:00 10/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [20:17:00 10/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:17:00 10/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.8 st: NotStopd t0: [20:17:00 10/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:17:00 10/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:17:00 10/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:17:00 10/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:17:00 10/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:17:00 10/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:17:00 10/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:17:00 10/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:17:00 10/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.44 u1: L/min st: NotStopd t0: [20:17:00 10/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:17:00 10/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:17:00 10/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [20:17:00 10/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [20:17:00 10/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [20:17:00 10/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [20:17:00 10/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:17:00 10/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:17:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:17:00 10/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:17:00 10/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:17:00 10/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:17:00 10/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:17:00 10/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:17:00 10/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:17:00 10/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [20:17:00 10/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:17:00 10/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [19:00:00 10/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [19:00:00 10/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [19:00:00 10/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 10/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 10/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 10/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 10/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 10/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [20:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 10/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 10/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 10/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 10/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Fair st: NotStopd t0: [20:00:00 10/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 10/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 10/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 10/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 10/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 10/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 10/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 10/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 10/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [20:00:00 10/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 10/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 10/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [20:00:00 10/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 10/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 10/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 10/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 10/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 10/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 10/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 10/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Cloudy st: NotStopd t0: [20:00:00 10/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 10/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 10/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [21:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [21:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 10/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [21:00:00 10/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [21:00:00 10/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [21:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [21:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [21:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [21:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [20:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [21:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [21:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [20:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 10/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 290 ap: none
t0: [20:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [20:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.6667 u1: mmHg st: NotStopd t0: [20:00:00 10/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 10/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [20:00:00 10/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd
t0: [22:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [22:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 99 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [22:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 65.6667 u1: mmHg st: NotStopd t0: [22:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [22:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [22:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 10/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 10/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 10/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 10/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 10/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 10/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [23:00:00 10/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 10/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [23:00:00 10/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 76.6667 u1: mmHg st: NotStopd t0: [23:00:00 10/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [23:00:00 10/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [23:00:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 10/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [22:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [23:00:00 10/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 10/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [23:00:00 10/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [22:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 10/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:40:00 10/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [23:40:00 10/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12 u1: ml/cmH st: NotStopd t0: [23:40:00 10/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [23:40:00 10/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [23:40:00 10/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 40 t0: [23:40:00 10/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [23:40:00 10/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [23:40:00 10/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.8 st: NotStopd t0: [23:40:00 10/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [23:40:00 10/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [23:40:00 10/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [23:40:00 10/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [23:40:00 10/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [23:40:00 10/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [23:40:00 10/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [23:40:00 10/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [23:40:00 10/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.46 u1: L/min st: NotStopd t0: [23:40:00 10/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [23:40:00 10/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [23:40:00 10/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [23:40:00 10/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [23:40:00 10/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [23:40:00 10/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [23:40:00 10/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [23:40:00 10/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [23:40:00 10/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [23:40:00 10/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [23:40:00 10/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [23:40:00 10/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 290 u1: ml/B st: NotStopd t0: [23:40:00 10/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [23:40:00 10/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [23:40:00 10/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [23:40:00 10/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [23:40:00 10/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [23:40:00 10/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [23:40:00 10/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [23:40:00 10/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [22:00:00 10/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [22:00:00 10/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 10/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [22:00:00 10/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [00:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [00:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [00:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [00:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [00:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [00:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [00:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [01:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 11/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [01:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [01:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 68.3333 u1: mmHg st: NotStopd t0: [01:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [01:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [01:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 11/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [01:00:00 11/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [01:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [01:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [01:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [02:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [02:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.3333 u1: mmHg st: NotStopd t0: [02:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [02:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [03:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [03:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [03:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [03:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [02:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [03:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [03:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [02:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 11/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 120 cv: 120 ap: none t0: [23:00:00 11/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -31 cv: -31 ap: none t0: [23:00:00 11/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 14 cv: 699.7 ap: none t0: [23:00:00 11/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 89 cv: 2689.7 ap: none t0: [23:00:00 11/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1800 ap: none t0: [23:00:00 11/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 120 cv: 2435 ap: none t0: [23:00:00 11/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -31 cv: -495.3 ap: none t0: [23:00:00 11/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 120 cv: 3185 ap: none t0: [23:00:00 11/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -31 cv: 7034.49 ap: carryForward
t0: [04:00:00 11/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 11/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 12 u1: ml/cmH st: NotStopd t0: [04:00:00 11/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 11/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 11/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:00:00 11/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:00:00 11/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:2.8 st: NotStopd t0: [04:00:00 11/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 11/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 11/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [04:00:00 11/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 11/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 11/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 11/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 11/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [04:00:00 11/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.5 u1: L/min st: NotStopd t0: [04:00:00 11/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 11/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 11/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:00:00 11/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [04:00:00 11/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [04:00:00 11/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [04:00:00 11/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 11/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 11/02/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [04:00:00 11/02/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.1 u1: L st: NotStopd t0: [04:00:00 11/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 11/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 11/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 11/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 11/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 11/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 11/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 11/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 11/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:00:00 11/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 11/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 11/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 11/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 11/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 11/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [04:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 11/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 11/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 11/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [04:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.6667 u1: mmHg st: NotStopd t0: [04:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [04:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [05:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [05:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [05:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 11/02/2016] id: Previous Weight el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [05:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [05:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [04:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [05:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [05:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [04:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:00:00 11/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 11/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3889 u1: Deg. C st: NotStopd t0: [04:00:00 11/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.3 u1: Deg. F st: NotStopd
t0: [04:50:00 11/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.1 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 8.1 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 27 u1: % rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 8.9 u1: gm/dl rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 702 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.03 u1: /mic l rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.1 rs: Final st: NotStopd
t0: [04:50:00 11/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 15.9 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 33.8 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 15.9 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 33.8 rs: Final st: NotStopd
t0: [04:50:00 11/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.3 u1: mg/dl rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 116 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.3 u1: mEq/L rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.3 u1: mg/dl rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 32 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 116 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.3 u1: mEq/L rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 rs: Final st: NotStopd t0: [04:50:00 11/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 137 rs: Final st: NotStopd
t0: [20:00:00 10/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 10/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 10/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 10/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 10/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 11/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 11/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 11/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 11/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [00:00:00 11/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 11/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 11/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 11/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 11/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 11/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 11/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 11/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 11/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 11/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 11/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 11/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [00:00:00 11/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 11/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 11/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 11/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 11/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 11/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 11/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 11/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [00:00:00 11/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 11/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 11/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 11/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 11/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 11/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 11/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 11/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 11/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 11/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 11/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 11/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 11/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 11/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 11/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [00:00:00 11/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 11/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [00:00:00 11/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 11/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [00:00:00 11/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 11/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 11/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 11/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 11/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 11/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [00:00:00 11/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 11/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [00:00:00 11/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [01:00:00 11/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [01:00:00 11/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [01:00:00 11/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [03:00:00 11/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [03:00:00 11/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [03:00:00 11/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [03:00:00 11/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [03:00:00 11/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [03:00:00 11/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [03:00:00 11/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [03:00:00 11/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [03:00:00 11/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [03:00:00 11/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [03:00:00 11/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [03:00:00 11/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [03:00:00 11/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [04:00:00 11/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 11/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 11/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [04:00:00 11/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 11/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 11/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 11/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [04:00:00 11/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 11/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 11/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 11/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 11/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 11/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 11/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 11/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 11/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 11/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [04:00:00 11/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 11/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 11/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 11/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 11/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 11/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 11/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 11/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 11/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 11/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 11/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 11/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 11/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [04:00:00 11/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 11/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [04:00:00 11/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 11/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done
t0: [06:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [06:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [06:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [06:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [06:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 11/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:00:00 11/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 11/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [08:00:00 11/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 4 t0: [08:00:00 11/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 4 t0: [08:00:00 11/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 11/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 30 t0: [08:00:00 11/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 11/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [08:00:00 11/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 11/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 11/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [08:00:00 11/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 11/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 3 st: NotStopd t0: [08:00:00 11/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 11/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 11/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 5.5 u1: L/min st: NotStopd t0: [08:00:00 11/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 11/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 11/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [08:00:00 11/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 97 u1: % st: NotStopd t0: [08:00:00 11/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [08:00:00 11/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [08:00:00 11/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 415 u1: ml/B st: NotStopd t0: [08:00:00 11/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 11/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 11/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 11/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 11/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [08:00:00 11/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 11/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 11/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [08:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [08:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [08:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [08:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 14 u1: BPM st: NotStopd t0: [08:00:00 11/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 11/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [08:00:00 11/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [08:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 6 vu: ml t0: [08:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [08:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 11/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 11/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 11/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 11/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 11/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 11/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 11/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 11/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 11/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 11/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 11/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 11/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 11/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 11/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 11/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 11/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 11/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 11/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 11/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 11/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 11/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 11/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 11/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 11/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 11/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 11/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:00:00 11/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 11/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 11/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 11/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 11/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 11/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 11/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 11/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 11/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 11/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 11/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 11/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 11/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 11/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 11/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 11/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [08:00:00 11/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 11/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 11/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 11/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 11/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 11/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 11/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [08:00:00 11/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd
t0: [09:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [09:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [09:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.3333 u1: mmHg st: NotStopd t0: [09:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [09:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [09:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [09:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [09:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
tf: [09:00:00 11/02/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Furosemide v1: 40 u1: mg m2: D5W v2: 50 u2: ml tf: [09:00:00 11/02/2016] pt: Unit Dose rt: PO fr: 4X/WEEK fs: 10 m1: Warfarin v1: 2 u1: mg tf: [09:00:00 12/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 10 dn: 1 m1: Potassium Phosphate v1: 30 u1: mmol m2: D5W v2: 250 u2: ml tf: [09:00:00 12/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 10 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm tf: [09:00:00 12/02/2016] pt: Unit Dose rt: PO fr: ONCE fs: 10 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq tf: [20:00:00 12/02/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Furosemide v1: 40 u1: mg m2: D5W v2: 50 u2: ml tf: [09:00:00 13/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Warfarin v1: 2 u1: mg tf: [11:00:00 14/02/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Furosemide v1: 80 u1: mg m2: D5W v2: 100 u2: ml tf: [10:00:00 16/02/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Sulfameth/Trimethoprim DS v1: 1 u1: TAB
t0: [10:39:00 11/02/2016] id: Blood Products Hematology el: 0 cu: MICU cg: 1663 v1: Y rs: Final st: NotStopd
t0: [11:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 11/02/2016] id: Readmit <48 hrs el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 11/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [11:00:00 11/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [11:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [11:00:00 11/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [11:00:00 11/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [11:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [11:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.3333 u1: mmHg st: NotStopd t0: [11:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [11:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd
t0: [11:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [10:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [11:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:30:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:30:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:30:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [11:30:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:30:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [11:30:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [11:30:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:30:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [11:30:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [11:30:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:30:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3 vu: ml t0: [11:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [11:30:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 11/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 11/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 11/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 11/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 11/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [08:00:00 11/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 11/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [08:00:00 11/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd
t0: [12:00:00 11/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:00:00 11/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 11/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [12:00:00 11/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 4 t0: [12:00:00 11/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 4 t0: [12:00:00 11/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 11/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 30 t0: [12:00:00 11/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:00:00 11/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [12:00:00 11/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 11/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 11/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 11/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 11/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 3 st: NotStopd t0: [12:00:00 11/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 11/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 11/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.4 u1: L/min st: NotStopd t0: [12:00:00 11/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 11/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 11/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [12:00:00 11/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:00:00 11/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 222 u1: ml/B st: NotStopd t0: [12:00:00 11/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 11/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:00:00 11/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:00:00 11/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:00:00 11/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [12:00:00 11/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [11:00:00 11/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [11:00:00 11/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 11/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [12:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 11/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 11/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 11/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 11/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 11/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [12:00:00 11/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 11/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 11/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [12:00:00 11/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 11/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 11/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [12:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 11/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 11/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 11/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 11/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 11/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 11/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 11/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 11/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 11/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 11/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 11/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [12:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [12:00:00 11/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 11/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [12:00:00 11/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 11/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [12:00:00 11/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 11/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [12:00:00 11/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 11/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 11/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [12:00:00 11/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 11/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 11/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Rectal Tube st: NotStopd t0: [12:00:00 11/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [12:00:00 11/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [12:00:00 11/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [12:00:00 11/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 11/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [12:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 11/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [12:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 3.5 vu: ml t0: [12:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [12:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [13:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [13:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [13:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104.667 u1: mmHg st: NotStopd t0: [13:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [13:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [13:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [13:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [13:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [13:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:00:00 11/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [14:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 11/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [14:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 11/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 11/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [14:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.6667 u1: mmHg st: NotStopd t0: [14:00:00 11/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 11/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 11/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [14:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 11/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 55 u1: kg st: NotStopd t0: [14:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [14:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 11/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: Airbed/Kinair st: NotStopd t0: [14:00:00 11/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 5 vu: ml t0: [14:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [14:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 11/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 11/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 11/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 11/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 11/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 11/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 11/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 11/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [16:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 11/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 11/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 11/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 11/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 11/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 11/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 11/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 11/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 11/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 11/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 11/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 11/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Dozing Intermit st: NotStopd t0: [16:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [16:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.6667 u1: mmHg st: NotStopd t0: [16:00:00 11/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 11/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 11/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 11/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 11/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [16:00:00 11/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 11/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 11/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 11/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 11/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 11/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 11/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:00:00 11/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 11/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [16:00:00 11/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [15:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [15:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [16:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [16:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [16:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [17:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 11/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [17:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [17:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 11/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 11/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [17:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [17:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [17:00:00 11/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 11/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [17:00:00 11/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [17:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 11/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [17:00:00 11/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [17:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [17:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [17:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 11/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 190 ap: none
t0: [17:23:00 11/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [17:23:00 11/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 0 u1: ml/cmH st: NotStopd t0: [17:23:00 11/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [17:23:00 11/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [17:23:00 11/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 4 t0: [17:23:00 11/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 4 t0: [17:23:00 11/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:23:00 11/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 30 t0: [17:23:00 11/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 36 u1: cmH2O st: NotStopd t0: [17:23:00 11/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [17:23:00 11/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:1 st: NotStopd t0: [17:23:00 11/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [17:23:00 11/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [17:23:00 11/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [17:23:00 11/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:23:00 11/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [17:23:00 11/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 8 v2: Albuterol st: NotStopd t0: [17:23:00 11/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:23:00 11/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [17:23:00 11/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.9 u1: L/min st: NotStopd t0: [17:23:00 11/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:23:00 11/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:23:00 11/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [17:23:00 11/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [17:23:00 11/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [17:23:00 11/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [17:23:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [17:23:00 11/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [17:23:00 11/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [17:23:00 11/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 200 u1: ml/B st: NotStopd t0: [17:23:00 11/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 0 u1: ml/B st: NotStopd t0: [17:23:00 11/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [17:23:00 11/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [17:23:00 11/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [17:23:00 11/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [17:23:00 11/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [17:23:00 11/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [17:23:00 11/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RRT v1: Exp Wheeze st: NotStopd t0: [17:23:00 11/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RRT v1: Exp Wheeze st: NotStopd t0: [17:23:00 11/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RRT v1: Exp Wheeze st: NotStopd t0: [17:23:00 11/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RRT v1: Exp Wheeze st: NotStopd t0: [17:23:00 11/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RRT v1: Tachypneic st: NotStopd
t0: [18:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [18:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [18:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.667 u1: mmHg st: NotStopd t0: [18:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 48 u1: BPM st: NotStopd t0: [18:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [18:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [18:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 11/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 750 ap: none
t0: [19:00:00 11/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [19:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 11/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 11/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [19:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [19:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [19:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [19:00:00 11/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [19:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [19:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 11/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [19:00:00 11/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [19:00:00 11/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.4 u1: Deg. F st: NotStopd t0: [19:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 11/02/2016] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: RN ai: -1 vu: ml nb: 1 t0: [19:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [19:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [19:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [20:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [20:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [19:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 11/02/2016] dt: 24 id: Blood Products Total el: 2 cu: MICU cg: RN cv: 0 ap: none
t0: [20:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [20:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [20:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [20:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [20:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 10/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RRT u1: kg st: NotStopd t0: [20:00:00 11/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 11/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 0 u1: ml/cmH st: NotStopd t0: [20:00:00 11/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 11/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [20:00:00 11/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 4 t0: [20:00:00 11/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 4 t0: [20:00:00 11/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 11/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 30 t0: [20:00:00 11/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 11/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [20:00:00 11/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:1 st: NotStopd t0: [20:00:00 11/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 11/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 11/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36.2 u1: Deg. C st: NotStopd t0: [20:00:00 11/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 11/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6.5 st: NotStopd t0: [20:00:00 11/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 11/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 11/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 18 u1: cmH2O st: NotStopd t0: [20:00:00 11/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.57 u1: L/min st: NotStopd t0: [20:00:00 11/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 11/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 11/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 32 u1: cmH2O st: NotStopd t0: [20:00:00 11/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [20:00:00 11/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [20:00:00 11/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 0 u1: BPM st: NotStopd t0: [20:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 11/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 330 u1: ml/B st: NotStopd t0: [20:00:00 11/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 0 u1: ml/B st: NotStopd t0: [20:00:00 11/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 11/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 11/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 11/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 11/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [20:00:00 11/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [21:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [21:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.3333 u1: mmHg st: NotStopd t0: [21:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [21:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [21:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [22:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [22:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [21:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 11/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [22:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [22:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.3333 u1: mmHg st: NotStopd t0: [22:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 15 u1: BPM st: NotStopd t0: [22:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 11/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 11/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 11/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 11/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 11/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 11/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [23:00:00 11/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 11/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 155 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [23:00:00 11/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [23:00:00 11/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 11/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [23:00:00 11/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 95 u1: % st: NotStopd t0: [23:00:00 11/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 11/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [23:00:00 11/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [23:00:00 11/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 11/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 12/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [00:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 12/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 12/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 12/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 12/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 12/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [00:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [00:00:00 12/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 12/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 12/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [00:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [00:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 12/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 12/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [00:00:00 12/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [00:00:00 12/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 12/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 12/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [01:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 159 u1: mmHg v2: 84 u2: mmHg st: NotStopd t0: [01:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 109 u1: mmHg st: NotStopd t0: [01:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [01:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 12/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [01:00:00 12/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [01:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [00:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [01:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [01:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [00:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip t0: [01:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 11/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 11/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 11/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 11/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 11/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 11/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 11/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 11/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 11/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 11/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 11/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 11/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 11/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 11/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 11/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Dozing Intermit st: NotStopd t0: [20:00:00 11/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 11/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 11/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 11/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 11/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 11/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 11/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 11/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 11/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 11/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [20:00:00 11/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 11/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [20:00:00 11/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [01:00:00 12/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [01:00:00 12/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [01:00:00 12/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [01:00:00 12/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [01:00:00 12/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [01:00:00 12/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [01:00:00 12/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [01:00:00 12/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [01:00:00 12/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36.3 u1: Deg. C st: NotStopd t0: [01:00:00 12/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [01:00:00 12/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6.5 st: NotStopd t0: [01:00:00 12/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [01:00:00 12/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [01:00:00 12/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 19 u1: cmH2O st: NotStopd t0: [01:00:00 12/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.1 u1: L/min st: NotStopd t0: [01:00:00 12/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [01:00:00 12/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [01:00:00 12/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [01:00:00 12/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [01:00:00 12/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [01:00:00 12/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 308 u1: ml/B st: NotStopd t0: [01:00:00 12/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [01:00:00 12/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [01:00:00 12/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [01:00:00 12/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [01:00:00 12/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [01:00:00 12/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [01:00:00 12/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [01:00:00 12/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 12/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 12/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 12/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 12/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 12/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 12/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 12/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 12/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 12/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 12/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 12/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 12/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 12/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 12/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 12/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 12/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 12/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 12/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [00:00:00 12/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 12/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 12/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 12/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 12/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 12/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 12/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 12/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [00:00:00 12/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 12/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 12/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 12/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 12/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 12/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [02:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [02:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [02:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77.6667 u1: mmHg st: NotStopd t0: [02:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [02:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [03:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [03:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.3333 u1: mmHg st: NotStopd t0: [03:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [03:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 91 u1: % st: NotStopd t0: [03:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [02:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [03:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [03:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [03:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [02:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip t0: [03:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 12/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 12/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 12/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 822 ap: none t0: [23:00:00 12/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN cv: 2707 ap: none t0: [23:00:00 12/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 1725 ap: none t0: [23:00:00 12/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 3000 ap: none t0: [23:00:00 12/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN cv: -643 ap: none t0: [23:00:00 12/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 3350 ap: none t0: [23:00:00 12/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN cv: 6391.49 ap: carryForward
t0: [01:00:00 12/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15.7895 u1: ml/cmH st: NotStopd t0: [01:00:00 12/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:10:00 12/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:10:00 12/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15 u1: ml/cmH st: NotStopd t0: [04:10:00 12/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:10:00 12/02/2016] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: PEEP >10 st: NotStopd t0: [04:10:00 12/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:10:00 12/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:10:00 12/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [04:10:00 12/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [04:10:00 12/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:10:00 12/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:10:00 12/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36.3 u1: Deg. C st: NotStopd t0: [04:10:00 12/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:10:00 12/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6.5 st: NotStopd t0: [04:10:00 12/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:10:00 12/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:10:00 12/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 16 u1: cmH2O st: NotStopd t0: [04:10:00 12/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.51 u1: L/min st: NotStopd t0: [04:10:00 12/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:10:00 12/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:10:00 12/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 30 u1: cmH2O st: NotStopd t0: [04:10:00 12/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [04:10:00 12/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 11 u1: BPM st: NotStopd t0: [04:10:00 12/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [04:10:00 12/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:10:00 12/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:10:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:10:00 12/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 330 u1: ml/B st: NotStopd t0: [04:10:00 12/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:10:00 12/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:10:00 12/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:10:00 12/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:10:00 12/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:10:00 12/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [04:10:00 12/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:10:00 12/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [04:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [04:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [04:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [04:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 12/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 12/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8333 u1: Deg. C st: NotStopd t0: [04:00:00 12/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.3 u1: Deg. F st: NotStopd t0: [04:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 12/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [05:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [05:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [05:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 39 u1: BPM st: NotStopd t0: [05:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [04:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [05:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [05:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [04:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [06:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [06:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.6667 u1: mmHg st: NotStopd t0: [06:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [06:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [06:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [06:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd
t0: [04:00:00 12/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 12/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 12/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 12/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 12/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 12/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 12/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 12/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 12/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 12/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [04:00:00 12/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 12/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 12/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 12/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 12/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 12/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 12/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [04:00:00 12/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 12/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 12/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 12/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 12/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 12/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [08:00:00 12/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:00:00 12/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 12/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [08:00:00 12/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 4 t0: [08:00:00 12/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 4 t0: [08:00:00 12/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 12/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 35 t0: [08:00:00 12/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 12/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [08:00:00 12/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 12/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 12/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [08:00:00 12/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 12/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6.5 st: NotStopd t0: [08:00:00 12/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 12/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 12/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.1 u1: L/min st: NotStopd t0: [08:00:00 12/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 12/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 49 u1: BPM st: NotStopd t0: [08:00:00 12/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [08:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 12/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [08:00:00 12/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [08:00:00 12/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 530 u1: ml/B st: NotStopd t0: [08:00:00 12/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 12/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 12/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 12/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 12/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [08:00:00 12/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 12/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 12/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 12/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 12/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 12/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 12/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 12/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 12/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 12/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 12/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 12/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 12/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 12/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 12/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 12/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [08:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 12/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 12/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 12/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 12/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 12/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 12/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 12/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 12/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 12/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 12/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 12/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 12/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 12/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 12/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 12/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 12/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [08:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.333 u1: mmHg st: NotStopd t0: [08:00:00 12/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 12/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 12/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 12/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 12/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 12/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 12/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 12/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 12/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 12/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [08:00:00 12/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 12/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 12/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 12/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 12/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 12/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 12/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [08:00:00 12/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 12/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 12/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 12/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.2222 u1: Deg. C st: NotStopd t0: [08:00:00 12/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99 u1: Deg. F st: NotStopd t0: [08:00:00 12/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 12/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 12/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 12/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 12/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 12/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 12/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 12/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 12/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [08:00:00 12/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [08:00:00 12/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 12/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 12/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 12/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 12/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [08:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 8 vu: ml t0: [08:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [08:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [05:30:00 12/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.2 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 15.4 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 9.2 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 33.1 u1: % rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.5 u1: gm/dl rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 15.4 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 802 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.67 u1: /mic l rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.2 rs: Final st: NotStopd
t0: [08:00:00 12/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.1 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 9.1 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 32.5 u1: % rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.5 u1: gm/dl rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 794 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.62 u1: /mic l rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 9.1 rs: Final st: NotStopd
t0: [08:00:00 12/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 16.2 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 33.5 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 16.2 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 33.5 rs: Final st: NotStopd
t0: [05:30:00 12/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 93 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 102 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 u1: mEq/L rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.5 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: 7 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 217 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 17 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 35 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 93 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 102 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: LDH Enzymes el: 0 cu: MICU cg: 1663 v1: 190 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.7 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.8 u1: mEq/L rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [05:30:00 12/02/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.5 rs: Final st: NotStopd
t0: [08:00:00 12/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Albumin Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 93 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.6 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 u1: mEq/L rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 134 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.5 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: 8 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Albumin (>3.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 221 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 35 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 93 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.6 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 136 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 u1: mEq/L rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 134 rs: Final st: NotStopd t0: [08:00:00 12/02/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.5 rs: Final st: NotStopd
t0: [09:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [09:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [09:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.3333 u1: mmHg st: NotStopd t0: [09:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 46 u1: BPM st: NotStopd t0: [09:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [09:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [09:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [09:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
tf: [09:00:00 11/02/2016] pt: Unit Dose rt: PO fr: QMOWEFR fs: 10 m1: Warfarin v1: 2.5 u1: mg tf: [09:00:00 13/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 10 dn: 1 m1: Magnesium Sulfate v1: 3 u1: gm m2: D5W v2: 250 u2: ml tf: [10:00:00 18/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Neutra-Phos v1: 1 u1: PKT
t0: [10:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 12/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 12/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [10:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 12/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 12/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [10:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.3333 u1: mmHg st: NotStopd t0: [10:00:00 12/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 12/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 12/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [10:00:00 12/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [10:00:00 12/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 12/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [10:00:00 12/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [10:00:00 12/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 12/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done\
t0: [10:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [10:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [10:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [11:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 41 u1: BPM st: NotStopd t0: [11:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [11:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [11:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:00:00 12/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 100 vu: ml
t0: [12:00:00 12/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:00:00 12/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 12/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [12:00:00 12/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 4 t0: [12:00:00 12/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 4 t0: [12:00:00 12/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 12/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 35 t0: [12:00:00 12/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:00:00 12/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [12:00:00 12/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 12/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 12/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [12:00:00 12/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 12/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 6.5 st: NotStopd t0: [12:00:00 12/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 12/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 12/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.4 u1: L/min st: NotStopd t0: [12:00:00 12/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 12/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [12:00:00 12/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [12:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:00:00 12/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 387 u1: ml/B st: NotStopd t0: [12:00:00 12/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 12/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:00:00 12/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:00:00 12/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:00:00 12/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [12:00:00 12/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [12:06:00 12/02/2016] id: Art.pH ABG el: 0 cu: MICU cg: 1663 v1: 7.43 rs: Final st: NotStopd t0: [12:06:00 12/02/2016] id: Arterial Base Excess ABG el: 0 cu: MICU cg: 1663 v1: 10 rs: Final st: NotStopd t0: [12:06:00 12/02/2016] id: Arterial CO2(Calc) ABG el: 0 cu: MICU cg: 1663 v1: 37 rs: Final st: NotStopd t0: [12:06:00 12/02/2016] id: Arterial PaCO2 ABG el: 0 cu: MICU cg: 1663 v1: 54 u1: mmHg rs: Final st: NotStopd t0: [12:06:00 12/02/2016] id: Arterial PaO2 ABG el: 0 cu: MICU cg: 1663 v1: 174 u1: mmHg rs: Final st: NotStopd t0: [12:06:00 12/02/2016] id: Arterial pH ABG el: 0 cu: MICU cg: 1663 v1: 7.43 rs: Final st: NotStopd
t0: [12:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [12:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [12:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [12:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 12/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 12/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [12:00:00 12/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [12:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [12:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [12:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:48:00 12/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 30
t0: [11:00:00 12/02/2016] id: HOB el: 0 cu: MICU cg: RN st: NotStopd t0: [12:00:00 12/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 12/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 12/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 12/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 12/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 12/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 12/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 12/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 12/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 12/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 12/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 12/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 12/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 12/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [12:00:00 12/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 12/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 12/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 12/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 12/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 12/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 12/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 12/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 12/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 12/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 12/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 12/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 12/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [12:00:00 12/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [12:00:00 12/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 12/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 12/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 12/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [13:00:00 12/02/2016] id: HOB el: 0 cu: MICU cg: RN st: NotStopd t0: [13:00:00 12/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [13:00:00 12/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [13:00:00 12/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [13:00:00 12/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [13:00:00 12/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [13:00:00 12/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [13:00:00 12/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 12/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [13:00:00 12/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 12/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [13:00:00 12/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [13:00:00 12/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [13:00:00 12/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [13:00:00 12/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd
t0: [13:00:00 12/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 147 rs: Manual st: NotStopd
t0: [12:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [13:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [13:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [13:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [13:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [13:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [14:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [14:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.3333 u1: mmHg st: NotStopd t0: [14:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 54 u1: BPM st: NotStopd t0: [14:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [14:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 8 vu: ml t0: [14:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [13:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [15:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [15:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [15:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [15:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [15:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [15:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:00:00 12/02/2016] id: Trach Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 12/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [13:00:00 12/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 12/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 12/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 12/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 12/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 12/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 12/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 12/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 12/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 12/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 12/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 12/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 12/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 12/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 12/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [16:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 12/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 12/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 12/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 12/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 12/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 12/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 12/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 12/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 12/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 12/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 12/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 12/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 12/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 12/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 12/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 12/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [16:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97.3333 u1: mmHg st: NotStopd t0: [16:00:00 12/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 12/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 12/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 12/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 12/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 12/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 12/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 12/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 12/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 12/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 12/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 12/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 12/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 12/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 12/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 12/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 12/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 12/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [16:00:00 12/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 12/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 12/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 12/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 12/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 12/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 12/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 12/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 12/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 12/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 12/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [16:00:00 12/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 12/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 12/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 12/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 12/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [16:00:00 12/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [16:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [16:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [16:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 12/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [16:00:00 12/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [16:00:00 12/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 12/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [16:00:00 12/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [16:00:00 12/02/2016] id: Trach Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [15:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 48 u1: BPM st: NotStopd t0: [16:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 50 u1: BPM st: NotStopd
t0: [17:00:00 12/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [17:00:00 12/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [17:00:00 12/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [17:00:00 12/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 4 t0: [17:00:00 12/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 4 t0: [17:00:00 12/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [17:00:00 12/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 30 t0: [17:00:00 12/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [17:00:00 12/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 65 u1: BPM st: NotStopd t0: [17:00:00 12/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [17:00:00 12/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [17:00:00 12/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 36 u1: Deg. C st: NotStopd t0: [17:00:00 12/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 12/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 3 st: NotStopd t0: [17:00:00 12/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 12/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:00:00 12/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.4 u1: L/min st: NotStopd t0: [17:00:00 12/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 12/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [17:00:00 12/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [17:00:00 12/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 234 u1: ml/B st: NotStopd t0: [17:00:00 12/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [17:00:00 12/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [17:00:00 12/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [17:00:00 12/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [17:00:00 12/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [17:00:00 12/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [17:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [17:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [17:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [17:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 49 u1: BPM st: NotStopd t0: [17:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [17:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [17:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [17:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [18:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [18:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [18:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 47 u1: BPM st: NotStopd t0: [18:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [18:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [18:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 12/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 350 ap: none
t0: [18:00:00 12/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 121 rs: Manual st: NotStopd
t0: [19:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [19:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [19:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [19:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [19:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [19:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [19:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [19:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 12/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 12/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [20:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [20:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88 u1: mmHg st: NotStopd t0: [20:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 52 u1: BPM st: NotStopd t0: [20:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 12/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 12/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [20:00:00 12/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd
t0: [20:00:00 12/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 12/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 12/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 12/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [20:00:00 12/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [20:00:00 12/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 12/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 12/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 12/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 12/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 12/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 12/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 12/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 12/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 12/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 12/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 12/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 12/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 12/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 12/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 12/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 12/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 12/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 12/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 12/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 12/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 12/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 12/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 12/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 12/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 12/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 12/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 12/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 12/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 12/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 12/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 12/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 12/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 12/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 12/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 12/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 12/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 12/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 12/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 12/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 12/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 12/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 12/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 12/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 12 u1: number st: NotStopd t0: [20:00:00 12/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd
t0: [20:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [20:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [21:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [21:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [21:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [20:00:00 12/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 12/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 12/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 5 t0: [20:00:00 12/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 4 t0: [20:00:00 12/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 2 t0: [20:00:00 12/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 12/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 30 t0: [20:00:00 12/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 12/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 65 u1: BPM st: NotStopd t0: [20:00:00 12/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 2:1 st: NotStopd t0: [20:00:00 12/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 12/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 12/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.7 u1: Deg. C st: NotStopd t0: [20:00:00 12/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 12/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 3 st: NotStopd t0: [20:00:00 12/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 12/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 12/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 22 u1: cmH2O st: NotStopd t0: [20:00:00 12/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.02 u1: L/min st: NotStopd t0: [20:00:00 12/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 12/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [20:00:00 12/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [20:00:00 12/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [20:00:00 12/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:00:00 12/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 12/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Copious st: NotStopd t0: [20:00:00 12/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 156 u1: ml/B st: NotStopd t0: [20:00:00 12/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 490 u1: ml/B st: NotStopd t0: [20:00:00 12/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 12/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 12/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 12/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 12/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [20:00:00 12/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 12/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 12/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [21:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 12/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 12/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [21:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 85 u2: mmHg st: NotStopd t0: [21:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 108.667 u1: mmHg st: NotStopd t0: [21:00:00 12/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 12/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 12/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 12/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 12/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 12/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [21:00:00 12/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [21:00:00 12/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [22:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 12/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 12/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [22:00:00 12/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [22:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [21:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 48 u1: BPM st: NotStopd t0: [22:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [22:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.6667 u1: mmHg st: NotStopd t0: [22:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [23:00:00 12/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 12/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 12/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 12/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 12/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 12/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [23:00:00 12/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 12/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [23:00:00 12/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78.6667 u1: mmHg st: NotStopd t0: [23:00:00 12/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 12/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 55 u1: BPM st: NotStopd t0: [23:00:00 12/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 12/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [00:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [00:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.3333 u1: mmHg st: NotStopd t0: [00:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 12/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 45 u1: BPM st: NotStopd
t0: [00:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [00:00:00 13/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 8 vu: ml t0: [00:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [00:00:00 13/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 13/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 21.4286 u1: ml/cmH st: NotStopd t0: [00:00:00 13/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 13/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 13/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [00:00:00 13/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [00:00:00 13/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [00:00:00 13/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 13/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 13/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 13/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 13/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 13/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 13/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 13/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [00:00:00 13/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.3 u1: L/min st: NotStopd t0: [00:00:00 13/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 13/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 13/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [00:00:00 13/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 8 u1: BPM st: NotStopd t0: [00:00:00 13/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [00:00:00 13/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 13/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 13/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 303 u1: ml/B st: NotStopd t0: [00:00:00 13/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 13/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 13/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 13/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 13/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 13/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 13/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 12/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [20:00:00 12/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 12/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serosanguinous v2: Small st: NotStopd t0: [20:00:00 12/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [00:00:00 13/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 13/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [01:00:00 13/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [01:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 13/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 13/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [01:00:00 13/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [01:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 13/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [01:00:00 13/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [01:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 13/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 3 To speech st: NotStopd t0: [01:00:00 13/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 10 u1: points st: NotStopd t0: [01:00:00 13/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [01:00:00 13/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [01:00:00 13/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [01:00:00 13/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [01:00:00 13/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [01:00:00 13/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [01:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 13/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 13/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [01:00:00 13/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [01:00:00 13/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [01:00:00 13/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [01:00:00 13/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 13/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [01:00:00 13/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [01:00:00 13/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [01:00:00 13/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip st: NotStopd t0: [01:00:00 13/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 13/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [01:00:00 13/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 13/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 13/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [01:00:00 13/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [01:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [01:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77.3333 u1: mmHg st: NotStopd t0: [01:00:00 13/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [01:00:00 13/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 13/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [01:00:00 13/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [01:00:00 13/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 13/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [01:00:00 13/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [01:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 13/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [01:00:00 13/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 13/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [01:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [01:00:00 13/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [01:00:00 13/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 13/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [01:00:00 13/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [01:00:00 13/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [01:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [01:00:00 13/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [01:00:00 13/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [01:00:00 13/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [01:00:00 13/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [01:00:00 13/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [01:00:00 13/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [01:00:00 13/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [01:00:00 13/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 13/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [01:00:00 13/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 13/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [01:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 13/02/2016] id: Fingerstick Glucose Chemistry el: 0 cu: MICU cg: RN v1: 114 rs: Manual st: NotStopd t0: [01:00:00 13/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [01:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 13/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [01:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [01:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 12/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 160 ap: none t0: [23:00:00 13/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 360 ap: none
t0: [02:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [02:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [02:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78.3333 u1: mmHg st: NotStopd t0: [02:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [02:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 13/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [02:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [23:00:00 13/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 40 cv: 40 ap: none t0: [23:00:00 13/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 50 cv: 50 ap: none t0: [23:00:00 13/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 15 cv: 758.25 ap: none t0: [23:00:00 13/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 90 cv: 2993.25 ap: none t0: [23:00:00 13/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 75 cv: 1875 ap: none t0: [23:00:00 13/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 40 cv: 2635 ap: none t0: [23:00:00 13/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 50 cv: 58.25 ap: none t0: [23:00:00 13/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 40 cv: 2935 ap: none t0: [23:00:00 13/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 50 cv: 6449.74 ap: carryForward
t0: [00:00:00 13/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd
t0: [02:00:00 13/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [02:00:00 13/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [02:00:00 13/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [02:00:00 13/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [02:00:00 13/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd
t0: [04:00:00 13/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 16.8 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 16.8 rs: Final st: NotStopd
t0: [04:00:00 13/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 126 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 133 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 35 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 126 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.5 rs: Final st: NotStopd t0: [04:00:00 13/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 133 rs: Final st: NotStopd
t0: [03:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [03:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [03:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [04:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [04:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.3333 u1: mmHg st: NotStopd t0: [04:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [04:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [05:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 145 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [05:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.6667 u1: mmHg st: NotStopd t0: [05:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [05:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 13/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [05:00:00 13/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [05:00:00 13/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [05:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [04:00:00 13/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 8 vu: ml t0: [04:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml t0: [05:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 13/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [05:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [03:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip t0: [05:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 13/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [02:00:00 13/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 13/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 13/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [05:00:00 13/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [05:00:00 13/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [05:00:00 13/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [05:00:00 13/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [05:00:00 13/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [05:00:00 13/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [05:00:00 13/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [05:00:00 13/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [05:00:00 13/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [05:00:00 13/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 13/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 13/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [05:00:00 13/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [05:00:00 13/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [05:00:00 13/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [05:00:00 13/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 13/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [05:00:00 13/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [05:00:00 13/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [05:00:00 13/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip st: NotStopd t0: [05:00:00 13/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 13/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [05:00:00 13/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 13/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [05:00:00 13/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [05:00:00 13/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 13/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Thrush st: NotStopd t0: [05:00:00 13/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 13/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 13/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [05:00:00 13/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [05:00:00 13/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 13/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [05:00:00 13/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [05:00:00 13/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 13/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [05:00:00 13/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 13/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [05:00:00 13/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [05:00:00 13/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [05:00:00 13/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [05:00:00 13/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [05:00:00 13/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [05:00:00 13/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 13/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [05:00:00 13/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 13/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [05:00:00 13/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 13/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done
t0: [06:00:00 13/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [06:00:00 13/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 20 u1: ml/cmH st: NotStopd t0: [06:00:00 13/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [06:00:00 13/02/2016] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: PEEP >10 st: NotStopd t0: [06:00:00 13/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [06:00:00 13/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [06:00:00 13/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [06:00:00 13/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [06:00:00 13/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [06:00:00 13/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [06:00:00 13/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [06:00:00 13/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [06:00:00 13/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [06:00:00 13/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [06:00:00 13/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [06:00:00 13/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [06:00:00 13/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.6 u1: L/min st: NotStopd t0: [06:00:00 13/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [06:00:00 13/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [06:00:00 13/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [06:00:00 13/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 21 u1: cmH2O st: NotStopd t0: [06:00:00 13/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 6 u1: BPM st: NotStopd t0: [06:00:00 13/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [06:00:00 13/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [06:00:00 13/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [06:00:00 13/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [06:00:00 13/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [06:00:00 13/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 383 u1: ml/B st: NotStopd t0: [06:00:00 13/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [06:00:00 13/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [06:00:00 13/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [06:00:00 13/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [06:00:00 13/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [06:00:00 13/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [06:00:00 13/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [06:00:00 13/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [06:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [06:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [06:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 76.3333 u1: mmHg st: NotStopd t0: [06:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [06:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 13/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 2 cu: MICU cg: RN ai: 354 vo: 4 vu: ml t0: [06:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [06:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:00:00 13/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:00:00 13/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 23.0769 u1: ml/cmH st: NotStopd t0: [08:00:00 13/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 13/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:00:00 13/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 13/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 13/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [08:00:00 13/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 13/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 13/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.6 u1: Deg. C st: NotStopd t0: [08:00:00 13/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 13/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [08:00:00 13/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [08:00:00 13/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.4 u1: L/min st: NotStopd t0: [08:00:00 13/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 13/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 13/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [08:00:00 13/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 20 u1: cmH2O st: NotStopd t0: [08:00:00 13/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 11 u1: BPM st: NotStopd t0: [08:00:00 13/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [08:00:00 13/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:00:00 13/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 13/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 295 u1: ml/B st: NotStopd t0: [08:00:00 13/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:00:00 13/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 13/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 13/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 13/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 13/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Assist Control st: NotStopd t0: [08:00:00 13/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:00:00 13/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 13/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 13/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 13/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 13/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 13/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 13/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 13/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 13/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 13/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 13/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 13/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 13/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 13/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 13/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 13/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 13/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [08:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 13/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 13/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 13/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 13/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 13/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 13/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 13/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 13/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 13/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 13/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 13/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 13/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 13/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 13/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 13/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 13/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [08:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [08:00:00 13/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 13/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 13/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 13/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 13/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 13/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 13/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 13/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 13/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 13/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 13/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [08:00:00 13/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 13/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 13/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 13/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 13/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 13/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [08:00:00 13/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:00:00 13/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 13/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 13/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [08:00:00 13/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [08:00:00 13/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 13/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 13/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 13/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 13/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 13/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [08:00:00 13/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [08:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [08:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [09:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [09:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [09:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [09:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [10:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [10:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [10:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102.667 u1: mmHg st: NotStopd t0: [10:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [10:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [10:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
tf: [09:00:00 14/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 10 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml tf: [09:00:00 14/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 10 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [10:00:00 13/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [10:00:00 13/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [10:00:00 13/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [10:00:00 13/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd
t0: [11:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [11:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [11:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [11:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [11:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [11:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
id: Lasix el: 101 cu: MICU cg: RN io: D5W 100.0ml + 80mghr Lasix IV Infusions am: 80 du: mghr rt: IV Drip
io: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ra: 10 ru: ml/hr
id: D5W el: 1 cu: MICU cg: RN io: D5W 100.0ml + 80mghr Lasix IV Infusions vo: 100 du: ml rt: Intravenous Push
t0: [11:30:00 13/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [11:30:00 13/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [11:30:00 13/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Hoyer st: NotStopd t0: [12:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [12:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 13/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 13/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 13/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [12:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104.667 u1: mmHg st: NotStopd t0: [12:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [12:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 13/02/2016] tf: [17:24:00 26/02/2016] dt: 19284 id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml t0: [09:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [11:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [12:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [12:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [12:00:00 13/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:00:00 13/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 16.6667 u1: ml/cmH st: NotStopd t0: [12:00:00 13/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 13/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:00:00 13/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:00:00 13/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [12:00:00 13/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [12:00:00 13/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 13/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 13/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.5 u1: Deg. C st: NotStopd t0: [12:00:00 13/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 13/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [12:00:00 13/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [12:00:00 13/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.2 u1: L/min st: NotStopd t0: [12:00:00 13/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:00:00 13/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 13/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [12:00:00 13/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [12:00:00 13/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [12:00:00 13/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [12:00:00 13/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 18 u1: BPM st: NotStopd t0: [12:00:00 13/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [12:00:00 13/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:00:00 13/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:00:00 13/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:00:00 13/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:00:00 13/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 233 u1: ml/B st: NotStopd t0: [12:00:00 13/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 13/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:00:00 13/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:00:00 13/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:00:00 13/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [12:00:00 13/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:00:00 13/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [13:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 13/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 13/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [13:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [13:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 13/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [13:00:00 13/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [13:00:00 13/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [13:00:00 13/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 13/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [13:00:00 13/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [13:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [13:00:00 13/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [13:00:00 13/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [13:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [14:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 92 u2: mmHg st: NotStopd t0: [14:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 107.667 u1: mmHg st: NotStopd t0: [14:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [14:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [13:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [14:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [13:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip t0: [14:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [15:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [15:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100.667 u1: mmHg st: NotStopd t0: [15:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [15:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [15:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [15:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 13/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 13/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 13/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 13/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 13/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 13/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 13/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 13/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [16:00:00 13/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 13/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 13/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [16:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 13/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 13/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 13/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 13/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 13/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 13/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 13/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 13/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 13/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 13/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 13/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 13/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 13/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [16:00:00 13/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [16:00:00 13/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 13/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 13/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [16:00:00 13/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [16:00:00 13/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 13/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 13/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 13/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 13/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [16:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [16:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [16:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:00:00 13/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 18.75 u1: ml/cmH st: NotStopd t0: [16:00:00 13/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:00:00 13/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:00:00 13/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [16:00:00 13/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [16:00:00 13/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 13/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 13/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.4 u1: Deg. C st: NotStopd t0: [16:00:00 13/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 13/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [16:00:00 13/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 13/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 13/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [16:00:00 13/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [16:00:00 13/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [16:00:00 13/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 13/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [16:00:00 13/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [16:00:00 13/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [16:00:00 13/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [16:00:00 13/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [16:00:00 13/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [16:00:00 13/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [16:00:00 13/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [16:00:00 13/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 13/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 295 u1: ml/B st: NotStopd t0: [16:00:00 13/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [16:00:00 13/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 260 u1: ml/B st: NotStopd t0: [16:00:00 13/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [16:00:00 13/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:00:00 13/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [16:00:00 13/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd
t0: [17:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [17:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [17:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.6667 u1: mmHg st: NotStopd t0: [17:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [17:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [17:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 8.75 vu: ml
t0: [16:30:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip t0: [17:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [18:00:00 13/02/2016] id: PressureReduceDevice el: 0 cu: MICU cg: -1 st: D/C'd
t0: [18:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 13/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 13/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 13/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [18:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.6667 u1: mmHg st: NotStopd t0: [18:00:00 13/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 13/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 13/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [18:00:00 13/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [18:00:00 13/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 13/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [18:00:00 13/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [18:00:00 13/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [18:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 13/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 60 vu: ml t0: [18:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [18:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 7.5 vu: ml
t0: [18:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 13/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 300 ap: none
t0: [18:00:00 13/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Plug st: NotStopd t0: [18:00:00 13/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [20:00:00 13/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 13/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 16.6667 u1: ml/cmH st: NotStopd t0: [20:00:00 13/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 13/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 13/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 13/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [20:00:00 13/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [20:00:00 13/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 13/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 13/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.4 u1: Deg. C st: NotStopd t0: [20:00:00 13/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 13/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 13/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 13/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 13/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [20:00:00 13/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [20:00:00 13/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:00:00 13/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 13/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [20:00:00 13/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [20:00:00 13/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [20:00:00 13/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [20:00:00 13/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 13 u1: BPM st: NotStopd t0: [20:00:00 13/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [20:00:00 13/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 13/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:00:00 13/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 307 u1: ml/B st: NotStopd t0: [20:00:00 13/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 13/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 13/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 13/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 13/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 13/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [20:00:00 13/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 13/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [20:00:00 13/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 13/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 13/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 13/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 13/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 13/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 13/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 13/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 13/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 13/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 13/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 13/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 13/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 13/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [20:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 13/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 13/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 13/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 13/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 13/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 13/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 13/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 13/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 13/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 13/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 13/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 13/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 13/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 13/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 13/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [20:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.3333 u1: mmHg st: NotStopd t0: [20:00:00 13/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 13/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 13/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 13/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 13/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 13/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 13/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [20:00:00 13/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 13/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 13/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 13/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 13/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 13/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 13/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [20:00:00 13/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 13/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 13/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [20:00:00 13/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [20:00:00 13/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 13/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 13/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 13/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 13/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 13/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 13/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [20:00:00 13/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 13/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 13/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [20:00:00 13/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 11 u1: number st: NotStopd t0: [20:00:00 13/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [21:00:00 13/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 13/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 13/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [21:00:00 13/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 13/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 13/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 13/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [21:00:00 13/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 13/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [21:00:00 13/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 13/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [20:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml t0: [20:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15 vu: ml
t0: [21:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [21:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [21:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [21:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [22:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [22:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 13/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [22:00:00 13/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [22:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [22:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [22:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [22:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [22:00:00 13/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [22:00:00 13/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [23:00:00 13/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 13/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 13/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 13/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 13/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 13/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [23:00:00 13/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 13/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 13/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [23:00:00 13/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 93 u1: % st: NotStopd t0: [23:00:00 13/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 13/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 13/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [23:00:00 13/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [22:14:00 13/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 91 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 111 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.7 u1: mEq/L rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 133 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 19 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.4 u1: mg/dl rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 36 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 91 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 111 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.7 u1: mEq/L rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd t0: [22:14:00 13/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 133 rs: Final st: NotStopd
t0: [00:00:00 14/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 14/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [00:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 14/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 14/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 14/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 14/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 14/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 14/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 14/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [00:00:00 14/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 14/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 14/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 14/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 14/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 14/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [00:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 14/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 14/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 14/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 14/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 14/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 14/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 14/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [00:00:00 14/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 14/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 14/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 14/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 14/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 14/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [00:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.6667 u1: mmHg st: NotStopd t0: [00:00:00 14/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 14/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 14/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 14/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 14/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 14/02/2016] id: Pain Management el: 1 cu: MICU cg: RN v1: PO Med st: NotStopd t0: [00:00:00 14/02/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 14/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 14/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 14/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 14/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 14/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [00:00:00 14/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 14/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 14/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 14/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 14/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 14/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 14/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [00:00:00 14/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 14/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 14/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 14/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.9444 u1: Deg. C st: NotStopd t0: [00:00:00 14/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.5 u1: Deg. F st: NotStopd t0: [00:00:00 14/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 14/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 14/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 14/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 14/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [00:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 14/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 14/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [00:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [00:00:00 14/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 7.5 vu: ml
t0: [20:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip t0: [21:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip t0: [22:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip t0: [23:00:00 13/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 6 du: mghr sv: 50 su: ml rt: IV Drip
t0: [00:00:00 14/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 14/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 18.75 u1: ml/cmH st: NotStopd t0: [00:00:00 14/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 14/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 14/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [00:00:00 14/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [00:00:00 14/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [00:00:00 14/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 14/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 14/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.4 u1: Deg. C st: NotStopd t0: [00:00:00 14/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 14/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 14/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 14/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 14/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [00:00:00 14/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.1 u1: L/min st: NotStopd t0: [00:00:00 14/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 14/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 14/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [00:00:00 14/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [00:00:00 14/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [00:00:00 14/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [00:00:00 14/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 7 u1: BPM st: NotStopd t0: [00:00:00 14/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 27 u1: BPM st: NotStopd t0: [00:00:00 14/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 14/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:00:00 14/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 292 u1: ml/B st: NotStopd t0: [00:00:00 14/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 14/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 14/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 14/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 14/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 14/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [00:00:00 14/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 14/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [01:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [01:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [01:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [01:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [01:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [01:00:00 14/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 7.5 vu: ml
t0: [01:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [02:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [02:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [02:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [02:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [02:00:00 14/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [02:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 14/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 120 cv: 120 ap: estimateVol t0: [23:00:00 14/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -49.5 cv: -49.5 ap: estimateVol t0: [23:00:00 14/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 10.5 cv: 585 ap: none t0: [23:00:00 14/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 70.5 cv: 2960 ap: none t0: [23:00:00 14/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1635 ap: none t0: [23:00:00 14/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 120 cv: 2110 ap: none t0: [23:00:00 14/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -49.5 cv: 850 ap: estimateVol t0: [23:00:00 14/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 120 cv: 2110 ap: estimateVol t0: [23:00:00 14/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -49.5 cv: 7299.74 ap: estimateVol
t0: [03:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [03:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [03:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [04:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [04:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.3333 u1: mmHg st: NotStopd t0: [04:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [04:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml t0: [04:00:00 14/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml
t0: [03:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:30:00 14/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.8 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 8.8 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 33.7 u1: % rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.4 u1: gm/dl rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 649 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.72 u1: /mic l rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 8.8 rs: Final st: NotStopd
t0: [04:00:00 14/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 14/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 18.75 u1: ml/cmH st: NotStopd t0: [04:00:00 14/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 14/02/2016] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: PEEP >10 st: NotStopd t0: [04:00:00 14/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 14/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:00:00 14/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [04:00:00 14/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [04:00:00 14/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 14/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 14/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.4 u1: Deg. C st: NotStopd t0: [04:00:00 14/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 14/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 14/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 14/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [04:00:00 14/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.7 u1: L/min st: NotStopd t0: [04:00:00 14/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 14/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 14/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [04:00:00 14/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [04:00:00 14/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [04:00:00 14/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [04:00:00 14/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 10 u1: BPM st: NotStopd t0: [04:00:00 14/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:00:00 14/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 14/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:00:00 14/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 322 u1: ml/B st: NotStopd t0: [04:00:00 14/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 14/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 14/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 14/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 14/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 14/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [04:00:00 14/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 14/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd t0: [04:30:00 14/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 17.5 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 17.5 rs: Final st: NotStopd
t0: [04:30:00 14/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 118 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 132 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 38 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 118 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [04:30:00 14/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 132 rs: Final st: NotStopd
t0: [00:00:00 14/02/2016] id: Pain Level el: 0 cu: MICU cg: RN v1: 4-Mild to Mod st: NotStopd t0: [00:00:00 14/02/2016] id: Pain Level (Rest) el: 0 cu: MICU cg: RN v1: 4-Mild to Mod st: NotStopd t0: [02:00:00 14/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [02:00:00 14/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 14/02/2016] id: Pain Level el: 0 cu: MICU cg: RN v1: 2-Mild st: NotStopd t0: [04:00:00 14/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 14/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 14/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 14/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 14/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [04:00:00 14/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 14/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 14/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 14/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [04:00:00 14/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 14/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 14/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 14/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 14/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 14/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 14/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 14/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 14/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 14/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 14/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [04:00:00 14/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 14/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 14/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [04:00:00 14/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 14/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 14/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 14/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 14/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 14/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 14/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 14/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 14/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 14/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 14/02/2016] id: Pain Level (Rest) el: 0 cu: MICU cg: RN v1: 2-Mild st: NotStopd t0: [04:00:00 14/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 14/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [04:00:00 14/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [04:00:00 14/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 14/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 14/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 14/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 14/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 14/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 14/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 14/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 14/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [04:00:00 14/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 14/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 14/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [04:00:00 14/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 14/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 14/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [04:00:00 14/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [04:00:00 14/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 14/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [04:00:00 14/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 14/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 14/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 14/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 14/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [05:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 14/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [05:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 14/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 14/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [05:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [05:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [05:00:00 14/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 14/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 14/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [05:00:00 14/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [05:00:00 14/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 14/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [05:00:00 14/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 14/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 14/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done
t0: [05:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [05:00:00 14/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [05:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [06:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 107 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [06:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [06:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [06:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [06:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml t0: [06:00:00 14/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [08:00:00 14/02/2016] id: GI Guaiac/ph el: 0 cu: MICU cg: -1 st: D/C'd t0: [08:00:00 14/02/2016] id: Total PEEP Level el: 0 cu: MICU cg: -1 st: D/C'd
t0: [08:00:00 14/02/2016] id: Packed RBC's IV Infusions el: 1 cu: MICU cg: -1 ai: -1 vo: 0 st: D/C'd
t0: [08:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 14/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 14/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 14/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 14/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 14/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 14/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 14/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 14/02/2016] id: GI#2 Tube PlaceCheck el: 0 cu: MICU cg: RN v1: Not Done st: NotStopd t0: [08:00:00 14/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 14/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 14/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 14/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [08:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 14/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 14/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 14/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 14/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 14/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 14/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 14/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 14/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 14/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 14/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 14/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 14/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 14/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 14/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 14/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 14/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 14/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [08:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [08:00:00 14/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 14/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 14/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 14/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 14/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 14/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 14/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 14/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [08:00:00 14/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 14/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 14/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 14/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 14/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm st: NotStopd t0: [08:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 14/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown st: NotStopd t0: [08:00:00 14/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 14/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 14/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [08:00:00 14/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [08:00:00 14/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 14/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 14/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:00:00 14/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 14/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 14/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 14/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 14/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [08:00:00 14/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 14/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 14/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 14/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 14/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [08:00:00 14/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml t0: [08:00:00 14/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 20 vu: ml
t0: [08:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [08:45:00 14/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:45:00 14/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 16.6667 u1: ml/cmH st: NotStopd t0: [08:45:00 14/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:45:00 14/02/2016] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [08:45:00 14/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [08:45:00 14/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:45:00 14/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [08:45:00 14/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [08:45:00 14/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:45:00 14/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:45:00 14/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:45:00 14/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:45:00 14/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:45:00 14/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Albuterol st: NotStopd t0: [08:45:00 14/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT st: NotStopd t0: [08:45:00 14/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [08:45:00 14/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.5 u1: L/min st: NotStopd t0: [08:45:00 14/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:45:00 14/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:45:00 14/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [08:45:00 14/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [08:45:00 14/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [08:45:00 14/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [08:45:00 14/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 5 u1: BPM st: NotStopd t0: [08:45:00 14/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 25 u1: BPM st: NotStopd t0: [08:45:00 14/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [08:45:00 14/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [08:45:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:45:00 14/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 290 u1: ml/B st: NotStopd t0: [08:45:00 14/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:45:00 14/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [08:45:00 14/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:45:00 14/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:45:00 14/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:45:00 14/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:45:00 14/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [08:45:00 14/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [08:45:00 14/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [09:30:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:30:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:30:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [09:30:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:30:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [09:30:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.3333 u1: mmHg st: NotStopd t0: [09:30:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:30:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [09:30:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:30:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:30:00 14/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 240 vu: ml t0: [09:30:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 7.5 vu: ml t0: [09:30:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 112.5 vu: ml t0: [09:30:00 14/02/2016] id: D5W 100.0ml + 80mghr Lasix IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15 vu: ml
t0: [09:30:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 14/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [11:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 14/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [11:00:00 14/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 14/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [11:00:00 14/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [11:00:00 14/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [11:00:00 14/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [11:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [11:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 14/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [11:00:00 14/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [11:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.6667 u1: mmHg st: NotStopd t0: [11:00:00 14/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [11:00:00 14/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [11:00:00 14/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 14/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [11:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [11:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 14/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [11:00:00 14/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [11:00:00 14/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [11:00:00 14/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [11:00:00 14/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [11:00:00 14/02/2016] id: Trach Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 14/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [11:00:00 14/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 7.5 vu: ml t0: [11:00:00 14/02/2016] tf: [10:00:00 15/02/2016] dt: 1380 id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 15 vu: ml t0: [11:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 112.5 vu: ml
t0: [11:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 8 du: mghr sv: 50 su: ml rt: IV Drip
t0: [11:00:00 14/02/2016] id: Previous Weight el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [11:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [11:00:00 14/02/2016] id: BSA - English el: 0 cu: MICU cg: RN v1: 0.977264 u1: m2 st: NotStopd t0: [11:00:00 14/02/2016] id: BSA - Metric el: 0 cu: MICU cg: RN v1: 1.14657 u1: m2 st: NotStopd t0: [11:00:00 14/02/2016] id: Weight Change el: 0 cu: MICU cg: RN v1: 0 u1: kg st: NotStopd t0: [11:00:00 14/02/2016] id: Daily Weight el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd
t0: [12:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [12:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [12:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 97.6667 u1: mmHg st: NotStopd t0: [12:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [12:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [12:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 14/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 14/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.5556 u1: Deg. C st: NotStopd t0: [12:00:00 14/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.8 u1: Deg. F st: NotStopd t0: [12:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 75 vu: ml
t0: [12:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 9 du: mghr sv: 50 su: ml rt: IV Drip
tf: [06:00:00 15/02/2016] pt: IV Piggyback rt: IV DRIP fr: INFUSION m1: Furosemide v1: 100 u1: mg m2: D5W v2: 50 u2: ml
t0: [12:30:00 14/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [12:30:00 14/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [12:40:00 14/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:40:00 14/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 15.7895 u1: ml/cmH st: NotStopd t0: [12:40:00 14/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:40:00 14/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [12:40:00 14/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:40:00 14/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [12:40:00 14/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [12:40:00 14/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:40:00 14/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:40:00 14/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:40:00 14/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:40:00 14/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:40:00 14/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [12:40:00 14/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Albuterol st: NotStopd t0: [12:40:00 14/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:40:00 14/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [12:40:00 14/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:40:00 14/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:40:00 14/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [12:40:00 14/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 29 u1: cmH2O st: NotStopd t0: [12:40:00 14/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [12:40:00 14/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [12:40:00 14/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 23 u1: BPM st: NotStopd t0: [12:40:00 14/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 43 u1: BPM st: NotStopd t0: [12:40:00 14/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [12:40:00 14/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [12:40:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:40:00 14/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 290 u1: ml/B st: NotStopd t0: [12:40:00 14/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:40:00 14/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 180 u1: ml/B st: NotStopd t0: [12:40:00 14/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:40:00 14/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:40:00 14/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:40:00 14/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:40:00 14/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [12:40:00 14/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [12:40:00 14/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [13:30:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:30:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:30:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:30:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:30:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:30:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [13:30:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:30:00 14/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [13:30:00 14/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [13:30:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [13:30:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.3333 u1: mmHg st: NotStopd t0: [13:30:00 14/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:30:00 14/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [13:30:00 14/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [13:30:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:30:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [13:30:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [13:30:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:30:00 14/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [13:30:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 14/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 100 vu: ml t0: [13:30:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 7.5 vu: ml t0: [13:30:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 16.875 vu: ml t0: [13:30:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 90 vu: ml
t0: [13:30:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 9 du: mghr sv: 50 su: ml rt: IV Drip
t0: [14:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [14:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [14:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.3333 u1: mmHg st: NotStopd t0: [14:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [14:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [14:00:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 5.625 vu: ml t0: [14:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml
t0: [14:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 9 du: mghr sv: 50 su: ml rt: IV Drip
t0: [15:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [15:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [15:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 82.6667 u1: mmHg st: NotStopd t0: [15:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [15:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [15:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 11.25 vu: ml t0: [15:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [15:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 9 du: mghr sv: 50 su: ml rt: IV Drip
id: Lasix el: 302 cu: MICU cg: RN io: D5W 50.0ml + 100mghr Lasix IV Infusions am: 100 du: mghr rt: IV Drip
io: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ra: 4.5 ru: ml/hr
id: D5W el: 3 cu: MICU cg: RN io: D5W 50.0ml + 100mghr Lasix IV Infusions vo: 50 du: ml rt: Intravenous Push
t0: [16:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 14/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 14/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 14/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 14/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 14/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 14/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 14/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 14/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 14/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 14/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 14/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [16:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 14/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 14/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 14/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 14/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 14/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 14/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 14/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 14/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Normal Saline st: NotStopd t0: [16:00:00 14/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 14/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 14/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 14/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [16:00:00 14/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 14/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 14/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 14/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 14/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 14/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 14/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 14/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [16:00:00 14/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [16:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.3333 u1: mmHg st: NotStopd t0: [16:00:00 14/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 14/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 14/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 14/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 14/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [16:00:00 14/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 14/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 14/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [16:00:00 14/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 14/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 14/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 14/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 14/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 14/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown st: NotStopd t0: [16:00:00 14/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [16:00:00 14/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 14/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 14/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [16:00:00 14/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [16:00:00 14/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 14/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 14/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:00:00 14/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 14/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 14/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 14/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 14/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [16:00:00 14/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [16:00:00 14/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 14/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [16:00:00 14/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [16:00:00 14/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [16:00:00 14/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [16:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 11.25 vu: ml t0: [16:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [16:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 50 su: ml rt: IV Drip
t0: [16:40:00 14/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:40:00 14/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 20 u1: ml/cmH st: NotStopd t0: [16:40:00 14/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:40:00 14/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [16:40:00 14/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:40:00 14/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [16:40:00 14/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [16:40:00 14/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:40:00 14/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:40:00 14/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:40:00 14/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:40:00 14/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:40:00 14/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Albuterol st: NotStopd t0: [16:40:00 14/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [16:40:00 14/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:40:00 14/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9 u1: L/min st: NotStopd t0: [16:40:00 14/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [16:40:00 14/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:40:00 14/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [16:40:00 14/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [16:40:00 14/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [16:40:00 14/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 16 u1: BPM st: NotStopd t0: [16:40:00 14/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [16:40:00 14/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [16:40:00 14/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [16:40:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [16:40:00 14/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 315 u1: ml/B st: NotStopd t0: [16:40:00 14/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [16:40:00 14/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 130 u1: ml/B st: NotStopd t0: [16:40:00 14/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:40:00 14/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:40:00 14/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:40:00 14/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:40:00 14/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [16:40:00 14/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [16:40:00 14/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [17:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [17:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [17:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [17:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [17:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 12.5 vu: ml t0: [17:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [17:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 10 du: mghr sv: 50 su: ml rt: IV Drip
t0: [17:30:00 14/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 100 vu: ml t0: [17:30:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [17:30:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [17:30:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml
t0: [23:00:00 14/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 740 ap: none
t0: [14:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [17:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [18:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 153 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [18:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [18:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [18:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [18:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 14/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [18:00:00 14/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [18:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [18:00:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 2.5 vu: ml t0: [18:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 30 vu: ml
t0: [18:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 11 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 14/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 14/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 14/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 14/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 14/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 14/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 14/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 14/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 14/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 14/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 14/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [20:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 14/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 14/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 14/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [20:00:00 14/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [20:00:00 14/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 14/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [20:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.333 u1: mmHg st: NotStopd t0: [20:00:00 14/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 14/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 14/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [20:00:00 14/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 14/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [20:00:00 14/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [20:00:00 14/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 14/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 14/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 14/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [20:00:00 14/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 14/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [20:00:00 14/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [20:00:00 14/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [20:00:00 14/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 14/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 14/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 11 vu: ml t0: [20:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [20:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 11 du: mghr sv: 50 su: ml rt: IV Drip
t0: [20:00:00 14/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 14/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 14/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 14/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 14/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 14/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [20:00:00 14/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 14/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 14/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 14/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 14/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 14/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 14/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 14/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 14/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 14/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 14/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 14/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 14/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 14/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 14/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 14/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm st: NotStopd t0: [20:00:00 14/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 14/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 14/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 14/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 14/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 14/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [20:00:00 14/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 14/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 14/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 14/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [20:00:00 14/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [20:00:00 14/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 14/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 18.75 u1: ml/cmH st: NotStopd t0: [20:00:00 14/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 14/02/2016] id: Cuff Pressure-Airway el: 0 cu: MICU cg: RRT v1: 23 u1: cmH2O st: NotStopd t0: [20:00:00 14/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [20:00:00 14/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 14/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:00:00 14/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [20:00:00 14/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 14/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 14/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 14/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 14/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 14/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Albuterol st: NotStopd t0: [20:00:00 14/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [20:00:00 14/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [20:00:00 14/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.5 u1: L/min st: NotStopd t0: [20:00:00 14/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:00:00 14/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [20:00:00 14/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [20:00:00 14/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 26 u1: cmH2O st: NotStopd t0: [20:00:00 14/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [20:00:00 14/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [20:00:00 14/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 14 u1: BPM st: NotStopd t0: [20:00:00 14/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [20:00:00 14/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [20:00:00 14/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [20:00:00 14/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 273 u1: ml/B st: NotStopd t0: [20:00:00 14/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [20:00:00 14/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 14/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 14/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 14/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 14/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [20:00:00 14/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [20:00:00 14/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [21:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [21:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [21:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [21:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [21:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [21:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 11 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [22:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [22:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [22:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [22:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [22:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 11 vu: ml t0: [22:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [22:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 11 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 14/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 14/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 14/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 14/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 14/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 14/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [23:00:00 14/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 14/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [23:00:00 14/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [23:00:00 14/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 14/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [23:00:00 14/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [23:00:00 14/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 14/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [00:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [00:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [00:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 14/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 14/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 5.5 vu: ml t0: [23:00:00 14/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [00:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 15/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 5.5 vu: ml t0: [00:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [23:00:00 14/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 11 du: mghr sv: 50 su: ml rt: IV Drip t0: [00:00:00 15/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 11 du: mghr sv: 50 su: ml rt: IV Drip
t0: [22:00:00 14/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [00:00:00 15/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 15/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 15/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 15/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 15/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 15/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 15/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 15/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 15/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 15/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 15/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 15/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 15/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 15/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [00:00:00 15/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 15/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [00:00:00 15/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [00:00:00 15/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [00:00:00 15/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 15/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 15/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Pink st: NotStopd t0: [00:00:00 15/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 15/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [00:00:00 15/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 15/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 15/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 15/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [00:00:00 15/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [00:00:00 15/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 15/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 15/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 15/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 15/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 15/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 15/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 15/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [00:00:00 15/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 15/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 15/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [00:00:00 15/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 15/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 15/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 15/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 15/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 15/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 15/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 15/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [00:00:00 15/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 15/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 15/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 15/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 15/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [00:00:00 15/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 15/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 15/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 15/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 15/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [23:00:00 14/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: estimateVol
t0: [00:00:00 15/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 15/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 17.6471 u1: ml/cmH st: NotStopd t0: [00:00:00 15/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 15/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [00:00:00 15/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [00:00:00 15/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [00:00:00 15/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [00:00:00 15/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 15/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 15/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 15/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 15/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 15/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Albuterol st: NotStopd t0: [00:00:00 15/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [00:00:00 15/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [00:00:00 15/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.7 u1: L/min st: NotStopd t0: [00:00:00 15/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 15/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [00:00:00 15/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [00:00:00 15/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [00:00:00 15/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [00:00:00 15/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [00:00:00 15/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [00:00:00 15/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [00:00:00 15/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [00:00:00 15/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [00:00:00 15/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 15/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [00:00:00 15/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 15/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [00:00:00 15/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 15/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 15/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 15/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 15/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [00:00:00 15/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [00:00:00 15/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [00:00:00 15/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 15/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [00:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78.3333 u1: mmHg st: NotStopd t0: [00:00:00 15/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 15/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 15/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3889 u1: Deg. C st: NotStopd t0: [00:00:00 15/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.5 u1: Deg. F st: NotStopd
t0: [01:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [01:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [01:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79.6667 u1: mmHg st: NotStopd t0: [01:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [01:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [01:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 15/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 5.5 vu: ml t0: [01:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [01:00:00 15/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 11 du: mghr sv: 50 su: ml rt: IV Drip
t0: [02:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [02:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [02:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 74.6667 u1: mmHg st: NotStopd t0: [02:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [02:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [02:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 15/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 5.5 vu: ml t0: [02:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [02:00:00 15/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 11 du: mghr sv: 50 su: ml rt: IV Drip
t0: [23:00:00 15/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 160 cv: 160 ap: none t0: [23:00:00 15/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -95 cv: -95 ap: none t0: [23:00:00 15/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 5 cv: 410.5 ap: none t0: [23:00:00 15/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 65 cv: 2090.5 ap: none t0: [23:00:00 15/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1440 ap: none t0: [23:00:00 15/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 160 cv: 3960 ap: none t0: [23:00:00 15/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -95 cv: -1869.5 ap: none t0: [23:00:00 15/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 160 cv: 3960 ap: none t0: [23:00:00 15/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -95 cv: 5430.24 ap: carryForward
t0: [03:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [03:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [03:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77.3333 u1: mmHg st: NotStopd t0: [03:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [03:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 19 u1: BPM st: NotStopd t0: [03:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 15/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [03:00:00 15/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [03:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 15/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [04:00:00 15/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [04:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [04:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.3333 u1: mmHg st: NotStopd t0: [04:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [04:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [04:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 15/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 11 vu: ml t0: [04:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [03:00:00 15/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 11 du: mghr sv: 50 su: ml rt: IV Drip t0: [04:00:00 15/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 13 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:00:00 15/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 15/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 15/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [04:00:00 15/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 15/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 15/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 15/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 15/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 15/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 15/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 15/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 15/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 15/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [04:00:00 15/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 15/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 15/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 15/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [04:00:00 15/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 15/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [04:00:00 15/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 15/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 15/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [04:00:00 15/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 15/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 15/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 15/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 15/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Rhonchi st: NotStopd t0: [04:00:00 15/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 15/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 15/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 15/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 15/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 15/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [04:00:00 15/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 15/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [04:00:00 15/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [04:00:00 15/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [04:00:00 15/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 15/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Bronchial st: NotStopd t0: [04:00:00 15/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 15/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 15/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 15/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 15/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 15/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [04:00:00 15/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [04:00:00 15/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [04:00:00 15/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [04:00:00 15/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 15/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 15/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [04:00:00 15/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [04:00:00 15/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 15/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 15/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [04:00:00 15/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done t0: [04:00:00 15/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 15/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd
t0: [04:00:00 15/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 10.7 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 10.7 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 33.1 u1: % rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.2 u1: gm/dl rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 725 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.58 u1: /mic l rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 10.7 rs: Final st: NotStopd
t0: [04:00:00 15/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 17.9 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 17.9 rs: Final st: NotStopd
t0: [04:00:00 15/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 15/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [04:00:00 15/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.4 u1: Deg. F st: NotStopd t0: [05:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 15/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [05:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 15/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 15/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [05:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [05:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 82 u1: mmHg st: NotStopd t0: [05:00:00 15/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 15/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [05:00:00 15/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [05:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [05:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 15/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [05:00:00 15/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [05:00:00 15/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [05:00:00 15/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [05:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 15/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 6.5 vu: ml t0: [05:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [05:00:00 15/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 13 du: mghr sv: 50 su: ml rt: IV Drip
t0: [04:00:00 15/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 15/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 16.6667 u1: ml/cmH st: NotStopd t0: [04:00:00 15/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 15/02/2016] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: PEEP >10 st: NotStopd t0: [04:00:00 15/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.4 u1: torr st: NotStopd t0: [04:00:00 15/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:00:00 15/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:00:00 15/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [04:00:00 15/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 15/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 15/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 15/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 15/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 15/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Albuterol st: NotStopd t0: [04:00:00 15/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 4 v2: Atrovent st: NotStopd t0: [04:00:00 15/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [04:00:00 15/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.5 u1: L/min st: NotStopd t0: [04:00:00 15/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 15/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [04:00:00 15/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [04:00:00 15/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 28 u1: cmH2O st: NotStopd t0: [04:00:00 15/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 25 u1: cmH2O st: NotStopd t0: [04:00:00 15/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [04:00:00 15/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 19 u1: BPM st: NotStopd t0: [04:00:00 15/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [04:00:00 15/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 15/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [04:00:00 15/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 302 u1: ml/B st: NotStopd t0: [04:00:00 15/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:00:00 15/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 15/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 15/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 15/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 15/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [04:00:00 15/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [04:00:00 15/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [04:00:00 15/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.6 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 89 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 106 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.7 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 132 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.6 u1: mg/dl rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 37 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 89 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 106 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.7 u1: mEq/L rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4 rs: Final st: NotStopd t0: [04:00:00 15/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 132 rs: Final st: NotStopd
t0: [05:00:00 15/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [05:00:00 15/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [05:00:00 15/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [05:00:00 15/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [05:00:00 15/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [05:00:00 15/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [05:00:00 15/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [05:00:00 15/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [05:00:00 15/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [05:00:00 15/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [05:00:00 15/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [05:00:00 15/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.5 u1: L/min st: NotStopd t0: [05:00:00 15/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [05:00:00 15/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [05:00:00 15/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [05:00:00 15/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [05:00:00 15/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [05:00:00 15/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 330 u1: ml/B st: NotStopd t0: [05:00:00 15/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [05:00:00 15/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [05:00:00 15/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [05:00:00 15/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [05:00:00 15/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [05:00:00 15/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [06:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [06:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [06:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [06:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [06:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 15/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: RN ai: 107 vo: 6.5 vu: ml t0: [06:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [06:00:00 15/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 v1: 13 du: mghr sv: 50 su: ml rt: IV Drip
t0: [07:00:00 15/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [07:00:00 15/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RRT v1: 17.6471 u1: ml/cmH st: NotStopd t0: [07:00:00 15/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [07:00:00 15/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [07:00:00 15/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [07:00:00 15/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 40 u1: BPM st: NotStopd t0: [07:00:00 15/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RRT v1: 1:3 st: NotStopd t0: [07:00:00 15/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [07:00:00 15/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [07:00:00 15/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:00:00 15/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:00:00 15/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [07:00:00 15/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [07:00:00 15/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.5 u1: L/min st: NotStopd t0: [07:00:00 15/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [07:00:00 15/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [07:00:00 15/02/2016] id: Peak Flow el: 0 cu: MICU cg: RRT u1: L/m st: NotStopd t0: [07:00:00 15/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RRT v1: 27 u1: cmH2O st: NotStopd t0: [07:00:00 15/02/2016] id: Plateau Pressure el: 0 cu: MICU cg: RRT v1: 24 u1: cmH2O st: NotStopd t0: [07:00:00 15/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 14 u1: . st: NotStopd t0: [07:00:00 15/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RRT v1: 15 u1: BPM st: NotStopd t0: [07:00:00 15/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [07:00:00 15/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [07:00:00 15/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [07:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [07:00:00 15/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 375 u1: ml/B st: NotStopd t0: [07:00:00 15/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [07:00:00 15/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [07:00:00 15/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [07:00:00 15/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [07:00:00 15/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [07:00:00 15/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: SIMV+PS st: NotStopd t0: [07:00:00 15/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd t0: [07:00:00 15/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RRT v1: RAMP st: NotStopd
t0: [08:00:00 15/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 15/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [08:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 15/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 15/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 15/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 15/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 15/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 15/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 15/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 15/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 15/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 15/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 15/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 15/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 15/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 15/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [08:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 15/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 15/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 15/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 15/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 15/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 15/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 15/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 15/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 15/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 15/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 15/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 15/02/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [08:00:00 15/02/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [08:00:00 15/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 15/02/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [08:00:00 15/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 15/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 15/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 15/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [08:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.3333 u1: mmHg st: NotStopd t0: [08:00:00 15/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 15/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 15/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [08:00:00 15/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 15/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 15/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [08:00:00 15/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 15/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 15/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 15/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 15/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 15/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 15/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 15/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [08:00:00 15/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [08:00:00 15/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 15/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 15/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 15/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 15/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 15/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [08:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [08:00:00 15/02/2016] id: Lasix el: 2 cu: MICU cg: RN so: D5W vo: 0 du: mghr sv: 50 su: ml rt: IV Drip st: Stopped
tf: [22:00:00 15/02/2016] pt: Unit Dose rt: IV fr: TID fs: 08, 16, 22 dn: 3 m1: Furosemide v1: 80 u1: mg tf: [22:00:00 15/02/2016] pt: Unit Dose rt: PO fr: TID fs: 08, 16, 22 dn: 3 m1: Metolazone v1: 2.5 u1: mg
t0: [09:00:00 15/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RT v1: 1 v2: 23 st: NotStopd t0: [09:00:00 15/02/2016] id: Compliance (40-60ml) el: 0 cu: MICU cg: RT v1: 18.75 u1: ml/cmH st: NotStopd t0: [09:00:00 15/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RT v1: No st: NotStopd t0: [09:00:00 15/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RT v1: 0.3 u1: torr st: NotStopd t0: [09:00:00 15/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RT v1: 40 u1: cmH2O st: NotStopd t0: [09:00:00 15/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RT v1: 40 u1: BPM st: NotStopd t0: [09:00:00 15/02/2016] id: I:E Ratio el: 0 cu: MICU cg: RT v1: 1:3 st: NotStopd t0: [09:00:00 15/02/2016] id: Airway Size el: 0 cu: MICU cg: RT v1: 8.0 mm st: NotStopd t0: [09:00:00 15/02/2016] id: Airway Type el: 0 cu: MICU cg: RT v1: Tracheostomy st: NotStopd t0: [09:00:00 15/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RT v1: 34.8 u1: Deg. C st: NotStopd t0: [09:00:00 15/02/2016] id: Intubation Date el: 0 cu: MICU cg: RT v1: 12 v2: 23 st: NotStopd t0: [09:00:00 15/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RT v1: 5 st: NotStopd t0: [09:00:00 15/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RT v1: 6 v2: Albuterol st: NotStopd t0: [09:00:00 15/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RT v1: 6 v2: Atrovent st: NotStopd t0: [09:00:00 15/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RT v1: 14 u1: cmH2O st: NotStopd t0: [09:00:00 15/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RT v1: 9.5 u1: L/min st: NotStopd t0: [09:00:00 15/02/2016] id: PEEP Set el: 0 cu: MICU cg: RT v1: 10 u1: cmH2O st: NotStopd t0: [09:00:00 15/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RT v1: 30 st: NotStopd t0: [09:00:00 15/02/2016] id: Peak Flow el: 0 cu: MICU cg: RT u1: L/m st: NotStopd t0: [09:00:00 15/02/2016] id: Peak Insp. Pressure el: 0 cu: MICU cg: RT v1: 26 u1: cmH2O st: NotStopd t0: [09:00:00 15/02/2016] id: Pressure Support el: 0 cu: MICU cg: RT v1: 14 u1: . st: NotStopd t0: [09:00:00 15/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: RT v1: 13 u1: BPM st: NotStopd t0: [09:00:00 15/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RT v1: 33 u1: BPM st: NotStopd t0: [09:00:00 15/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: RT v1: 20 u1: BPM st: NotStopd t0: [09:00:00 15/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RT v1: 3 u1: cmH2O st: NotStopd t0: [09:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RT v1: 100 u1: % st: NotStopd t0: [09:00:00 15/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RT v1: 322 u1: ml/B st: NotStopd t0: [09:00:00 15/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: RT v1: 300 u1: ml/B st: NotStopd t0: [09:00:00 15/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RT v1: 202 u1: ml/B st: NotStopd t0: [09:00:00 15/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RT v1: Yes v2: No st: NotStopd t0: [09:00:00 15/02/2016] id: Trach Size el: 0 cu: MICU cg: RT v1: #8 st: NotStopd t0: [09:00:00 15/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RT v1: Inflated st: NotStopd t0: [09:00:00 15/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RT v1: Portex st: NotStopd t0: [09:00:00 15/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RT v1: SIMV+PS st: NotStopd t0: [09:00:00 15/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RT v1: Drager st: NotStopd t0: [09:00:00 15/02/2016] id: Waveform-Vent el: 0 cu: MICU cg: RT v1: RAMP st: NotStopd
t0: [09:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [09:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [09:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [09:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [09:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [09:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [10:00:00 15/02/2016] id: D5W 50.0ml + 100mghr Lasix IV Infusions el: 3 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd
tf: [06:00:00 15/02/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metolazone v1: 5 u1: mg
t0: [10:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [10:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [10:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.6667 u1: mmHg st: NotStopd t0: [10:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [10:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [10:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [11:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [11:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [11:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.3333 u1: mmHg st: NotStopd t0: [11:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [11:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [11:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [12:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 15/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 15/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 15/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 15/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 15/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 15/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 15/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 15/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 15/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [12:00:00 15/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 15/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 15/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [12:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 15/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 15/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 15/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 15/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 15/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [12:00:00 15/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [12:00:00 15/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 15/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [12:00:00 15/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 15/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 15/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 15/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 15/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 15/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 15/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 15/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 15/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 15/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [12:00:00 15/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 15/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 15/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [12:00:00 15/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 15/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 15/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 15/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 15/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 15/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 15/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 15/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [12:00:00 15/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [12:00:00 15/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [12:00:00 15/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 15/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 15/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 15/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 15/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [12:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [12:00:00 15/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 15/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:00:00 15/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [12:00:00 15/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 15/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 15/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.8 u1: Deg. C st: NotStopd t0: [12:00:00 15/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 15/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 15/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [12:00:00 15/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [12:00:00 15/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [12:00:00 15/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [12:00:00 15/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 22 u1: . st: NotStopd t0: [12:00:00 15/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [12:00:00 15/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [12:00:00 15/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [12:00:00 15/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:00:00 15/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
tf: [09:00:00 23/02/2016] pt: Unit Dose rt: PO fr: QID fs: 10, 14, 18, 22 dn: 4 m1: Sucralfate v1: 1 u1: gm
t0: [13:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [13:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [13:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [13:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [13:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [13:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [14:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [14:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [14:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [15:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [15:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [15:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [15:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [16:00:00 15/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 15/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:00:00 15/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [16:00:00 15/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 15/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 15/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.8 u1: Deg. C st: NotStopd t0: [16:00:00 15/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 15/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 15/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 15/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 15/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [16:00:00 15/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.3 u1: L/min st: NotStopd t0: [16:00:00 15/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [16:00:00 15/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [16:00:00 15/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 22 u1: . st: NotStopd t0: [16:00:00 15/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [16:00:00 15/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [16:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [16:00:00 15/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [16:00:00 15/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 15/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 390 u1: ml/B st: NotStopd t0: [16:00:00 15/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:00:00 15/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [12:00:00 15/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 15/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 15/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Non-verbal cues st: NotStopd t0: [16:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 15/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 15/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 15/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 15/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 15/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 15/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 15/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [16:00:00 15/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 15/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 15/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 15/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 15/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 15/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [16:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 15/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 15/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 15/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 15/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 15/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 15/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 15/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 15/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 15/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 15/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 15/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 15/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 15/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 15/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 15/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [16:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79.6667 u1: mmHg st: NotStopd t0: [16:00:00 15/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 15/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 15/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [16:00:00 15/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 15/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [16:00:00 15/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 15/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 15/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 15/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 15/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 15/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 15/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 15/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [16:00:00 15/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [16:00:00 15/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 15/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 15/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 15/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 15/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 15/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 15/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [16:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [23:00:00 15/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 240 ap: none
t0: [17:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [17:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [17:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [17:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [17:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [17:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [18:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [18:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.6667 u1: mmHg st: NotStopd t0: [18:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [18:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [18:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [20:00:00 15/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 15/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 15/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 15/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:00:00 15/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [20:00:00 15/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 15/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 15/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [20:00:00 15/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 15/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:00:00 15/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 15/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 15/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 15/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.1 u1: L/min st: NotStopd t0: [20:00:00 15/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:00:00 15/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [20:00:00 15/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 22 u1: . st: NotStopd t0: [20:00:00 15/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [20:00:00 15/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [20:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:00:00 15/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 15/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 15/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 623 u1: ml/B st: NotStopd t0: [20:00:00 15/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 15/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 15/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 15/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 15/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 15/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [19:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [19:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [19:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [19:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [20:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [20:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [20:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 15/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [21:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 15/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [21:00:00 15/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [21:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 15/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [21:00:00 15/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [21:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 15/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [21:00:00 15/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 15/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [21:00:00 15/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [21:00:00 15/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [21:00:00 15/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [21:00:00 15/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [21:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [21:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 15/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 15/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [21:00:00 15/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [21:00:00 15/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [21:00:00 15/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [21:00:00 15/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [21:00:00 15/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [21:00:00 15/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 15/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 15/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [21:00:00 15/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [21:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [21:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [21:00:00 15/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [21:00:00 15/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [21:00:00 15/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [21:00:00 15/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [21:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [21:00:00 15/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 15/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [21:00:00 15/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [21:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [21:00:00 15/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [21:00:00 15/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 15/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 15/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: White v2: Thick st: NotStopd t0: [21:00:00 15/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [21:00:00 15/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Golden v2: Loose st: NotStopd t0: [21:00:00 15/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [21:00:00 15/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [21:00:00 15/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [21:00:00 15/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [21:00:00 15/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [21:00:00 15/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [21:00:00 15/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [21:00:00 15/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [21:00:00 15/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [21:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [21:00:00 15/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [19:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [20:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [21:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
tf: [10:00:00 16/02/2016] pt: Unit Dose rt: IV fr: BID fs: 10, 22 dn: 2 m1: Furosemide v1: 80 u1: mg tf: [10:00:00 16/02/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metolazone v1: 2.5 u1: mg
t0: [20:00:00 15/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 15/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 15/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 15/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 15/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 15/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 15/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 15/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 15/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 15/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 15/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [22:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [22:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 15/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 123 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [22:00:00 15/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86.3333 u1: mmHg st: NotStopd t0: [22:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [22:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [22:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [23:00:00 15/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 15/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [00:00:00 16/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 16/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 16/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 16/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [00:00:00 16/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [00:00:00 16/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 16/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 16/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [00:00:00 16/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 16/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 16/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 16/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 16/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 16/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.8 u1: L/min st: NotStopd t0: [00:00:00 16/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 16/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [00:00:00 16/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 22 u1: . st: NotStopd t0: [00:00:00 16/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [00:00:00 16/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [00:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 16/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 324 u1: ml/B st: NotStopd t0: [00:00:00 16/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 16/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 16/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 16/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 16/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 16/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [23:00:00 15/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 15/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 15/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 15/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 15/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 15/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [23:00:00 15/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 15/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 15/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [23:00:00 15/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [23:00:00 15/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 15/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 16/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 16/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 16/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 16/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [00:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 16/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 16/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [00:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104.667 u1: mmHg st: NotStopd t0: [00:00:00 16/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 16/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 16/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 16/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [00:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 16/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [00:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [00:00:00 16/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 16/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [00:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 16/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [01:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 16/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [01:00:00 16/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [01:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 16/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [01:00:00 16/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [01:00:00 16/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [01:00:00 16/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [01:00:00 16/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [01:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [01:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 16/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 16/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [01:00:00 16/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [01:00:00 16/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [01:00:00 16/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [01:00:00 16/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [01:00:00 16/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [01:00:00 16/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 16/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [01:00:00 16/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [01:00:00 16/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [01:00:00 16/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [01:00:00 16/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 16/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [01:00:00 16/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 16/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 16/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [01:00:00 16/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [01:00:00 16/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [01:00:00 16/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [01:00:00 16/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [01:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 16/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [01:00:00 16/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 16/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [01:00:00 16/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [01:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [01:00:00 16/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [01:00:00 16/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 16/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [01:00:00 16/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [01:00:00 16/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [01:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 16/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [01:00:00 16/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [01:00:00 16/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [01:00:00 16/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [01:00:00 16/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [01:00:00 16/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [01:00:00 16/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [01:00:00 16/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [01:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 16/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [01:00:00 16/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Walks Occasional st: NotStopd t0: [01:00:00 16/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [01:00:00 16/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [01:00:00 16/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [01:00:00 16/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [01:00:00 16/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 17 u1: number st: NotStopd t0: [01:00:00 16/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd
t0: [00:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [01:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [23:00:00 16/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 16/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 16/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 680 ap: none t0: [23:00:00 16/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN cv: 1880 ap: none t0: [23:00:00 16/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 180 ap: none t0: [23:00:00 16/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 1020 ap: none t0: [23:00:00 16/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 2255 ap: none t0: [23:00:00 16/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN cv: -375 ap: none t0: [23:00:00 16/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 2255 ap: none t0: [23:00:00 16/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN cv: 5055.24 ap: carryForward
t0: [02:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [02:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [02:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79.3333 u1: mmHg st: NotStopd t0: [02:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 16/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [02:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [02:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 16/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 16/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 16/02/2016] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: PEEP >10 st: NotStopd t0: [04:00:00 16/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 16/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:00:00 16/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [04:00:00 16/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 16/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 16/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [04:00:00 16/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 16/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 16/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 16/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 16/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [04:00:00 16/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [04:00:00 16/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [04:00:00 16/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [04:00:00 16/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 18 u1: . st: NotStopd t0: [04:00:00 16/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:00:00 16/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [04:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 16/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [04:00:00 16/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [04:00:00 16/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [04:00:00 16/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 16/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 16/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 16/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 16/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:00:00 16/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [03:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [03:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 16/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [03:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [03:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 16/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 16/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 16/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 71 u1: BPM st: NotStopd t0: [04:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [04:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [04:00:00 16/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 16/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [04:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [04:00:00 16/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [04:00:00 16/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6111 u1: Deg. C st: NotStopd t0: [04:00:00 16/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.9 u1: Deg. F st: NotStopd t0: [04:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 16/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [05:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 16/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [05:00:00 16/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [05:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 16/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 16/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [05:00:00 16/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [05:00:00 16/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [05:00:00 16/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [05:00:00 16/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [05:00:00 16/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 72 u1: BPM st: NotStopd t0: [05:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 16/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 16/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [05:00:00 16/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [05:00:00 16/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [05:00:00 16/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [05:00:00 16/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 16/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [05:00:00 16/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [05:00:00 16/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [05:00:00 16/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 16/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 16/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [05:00:00 16/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [05:00:00 16/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 16/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [05:00:00 16/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [05:00:00 16/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 16/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [05:00:00 16/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [05:00:00 16/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 16/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [05:00:00 16/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 16/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 16/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [05:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [05:00:00 16/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [05:00:00 16/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 16/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [05:00:00 16/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 16/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [05:00:00 16/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [05:00:00 16/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [05:00:00 16/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [05:00:00 16/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [05:00:00 16/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 16/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [05:00:00 16/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 16/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: DONE t0: [05:00:00 16/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [02:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [03:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [04:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [05:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml t0: [06:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [05:30:00 16/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 11.7 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 11.7 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 34.2 u1: % rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.8 u1: gm/dl rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 656 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.79 u1: /mic l rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 11.7 rs: Final st: NotStopd
t0: [05:30:00 16/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 9.2 u1: mg/dl rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 84 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 110 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 u1: mEq/L rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 9.2 u1: mg/dl rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 40 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 84 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 110 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.4 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.4 u1: mEq/L rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [05:30:00 16/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd
t0: [07:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 80 u1: BPM st: NotStopd t0: [07:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [07:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103 u1: mmHg st: NotStopd t0: [07:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 16/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [07:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [07:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 16/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 16/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [08:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [08:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.3333 u1: mmHg st: NotStopd t0: [08:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 16/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [08:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 39 u1: BPM st: NotStopd t0: [08:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 16/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 16/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [08:00:00 16/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [08:00:00 16/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 16/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 16/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [08:00:00 16/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 16/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 16/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 16/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 16/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 16/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9 u1: L/min st: NotStopd t0: [08:00:00 16/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [08:00:00 16/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [08:00:00 16/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 18 u1: . st: NotStopd t0: [08:00:00 16/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 42 u1: BPM st: NotStopd t0: [08:00:00 16/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [08:00:00 16/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [08:00:00 16/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [08:00:00 16/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [08:00:00 16/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 16/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 16/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 16/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [08:00:00 16/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 16/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 16/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 16/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 16/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 16/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 16/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 16/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 16/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 16/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 16/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 16/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 16/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 16/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 16/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 16/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 16/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 16/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 16/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 16/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 16/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [08:00:00 16/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 16/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 16/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 16/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 16/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 16/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [09:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Rare st: NotStopd t0: [09:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PVC's st: NotStopd t0: [09:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [09:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [09:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 74.6667 u1: mmHg st: NotStopd t0: [09:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 16/02/2016] id: Previous WeightF el: 0 cu: MICU cg: RN v1: 53 u1: kg st: NotStopd t0: [09:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 45 u1: BPM st: NotStopd t0: [09:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [08:00:00 16/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 16/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [08:00:00 16/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 16/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 16/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 16/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 16/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 16/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 16/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 16/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Walks Occasional st: NotStopd t0: [08:00:00 16/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 16/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 16/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 16/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 16/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [08:00:00 16/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd
id: Potassium Phosphate el: 200 cu: MICU cg: RN io: .9% Normal Saline 250.0ml IV Infusions am: 15 du: mEq rt: Intravenous Push
io: .9% Normal Saline 250.0ml IV Infusions el: 2 cu: MICU cg: RN ra: 43 ru: ml/hr
tf: [11:00:00 17/02/2016] pt: Unit Dose rt: IV fr: QD fs: 10 dn: 1 m1: Furosemide v1: 80 u1: mg tf: [11:00:00 17/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Metolazone v1: 2.5 u1: mg tf: [10:00:00 18/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Warfarin v1: 1 u1: mg
id: .9% Normal Saline el: 2 cu: MICU cg: RN io: .9% Normal Saline 250.0ml IV Infusions vo: 250 du: ml rt: Intravenous Infusion id: .9% Normal Saline el: 3 cu: MICU cg: RN io: .9% Normal Saline 1000.0ml IV Infusions vo: 1000 du: ml rt: Intravenous Push
t0: [10:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml st: Stopped t0: [11:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 2 cu: MICU cg: RN ai: -1 vo: 0 vu: ml nb: 1
tf: [11:00:00 16/02/2016] pt: Unit Dose rt: PO fr: ONCE fs: 11 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq tf: [11:00:00 16/02/2016] pt: Unit Dose rt: PO fr: ONCE fs: 11 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq tf: [10:00:00 17/02/2016] pt: IV Large Volume rt: IV fr: ONCE fs: 11 dn: 1 m1: Potassium Phosphate v1: 15 u1: mmol m2: NS v2: 250 u2: ml tf: [10:00:00 17/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 11 dn: 1 m1: Magnesium Sulfate v1: 4 u1: gm m2: NS v2: 250 u2: ml
t0: [10:10:00 16/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 15.6 rs: Final st: NotStopd t0: [10:10:00 16/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [10:10:00 16/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [10:10:00 16/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 15.6 rs: Final st: NotStopd
t0: [08:00:00 16/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 16/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [08:00:00 16/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 16/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 16/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [08:00:00 16/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 16/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [09:00:00 16/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 16/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [09:00:00 16/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 16/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 16/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 16/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 16/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 16/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [09:00:00 16/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [09:00:00 16/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [10:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [10:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [10:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 46 u1: BPM st: NotStopd t0: [10:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [11:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 164 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [11:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 106 u1: mmHg st: NotStopd t0: [11:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 47 u1: BPM st: NotStopd t0: [11:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 16/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 16/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 16/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 16/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 16/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 16/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [12:00:00 16/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 16/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 16/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 16/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 16/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 16/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 16/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 16/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd
tf: [11:00:00 17/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 12 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq m2: SW v2: 100 u2: ml
t0: [12:00:00 16/02/2016] id: plow el: 0 cu: MICU cg: RRT v1: 0 t0: [12:00:00 16/02/2016] id: T high el: 0 cu: MICU cg: RRT v1: 2 t0: [12:00:00 16/02/2016] id: T low el: 0 cu: MICU cg: RRT v1: 0.3 t0: [12:00:00 16/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 16/02/2016] id: pinsp el: 0 cu: MICU cg: RRT v1: 15 t0: [12:00:00 16/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:00:00 16/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [12:00:00 16/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 16/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 16/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [12:00:00 16/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 16/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 16/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 16/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 16/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8 u1: L/min st: NotStopd t0: [12:00:00 16/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [12:00:00 16/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [12:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:00:00 16/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [12:00:00 16/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [12:00:00 16/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 16/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 16/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [08:00:00 16/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [12:00:00 16/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 16/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [12:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 16/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 16/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [12:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [12:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.6667 u1: mmHg st: NotStopd t0: [12:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 39 u1: BPM st: NotStopd t0: [12:00:00 16/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 16/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [12:00:00 16/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [12:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 16/02/2016] tf: [16:00:00 16/02/2016] dt: 240 id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [12:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 2 cu: MICU cg: RN ai: -1 vo: 43 vu: ml
t0: [13:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [13:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 163 u1: mmHg v2: 90 u2: mmHg st: NotStopd t0: [13:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 114.333 u1: mmHg st: NotStopd t0: [13:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 16/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 16/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 16/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 16/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 16/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 16/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [12:00:00 16/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 16/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 16/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 16/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 16/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 16/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 16/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 16/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 16/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 16/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [12:00:00 16/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 16/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 16/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 16/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [12:00:00 16/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 16/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 16/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 16/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [13:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 45 u1: BPM st: NotStopd t0: [14:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [14:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 16/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [14:00:00 16/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [14:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [14:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 108.667 u1: mmHg st: NotStopd t0: [14:00:00 16/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 16/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 48 u1: BPM st: NotStopd t0: [14:00:00 16/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 16/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 2 cu: MICU cg: RN ai: -1 vo: 86 vu: ml
t0: [12:00:00 16/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 16/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 16/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [14:00:00 16/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3333 u1: Deg. C st: NotStopd t0: [14:00:00 16/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.4 u1: Deg. F st: NotStopd
t0: [14:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd
t0: [15:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [15:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [15:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84 u1: mmHg st: NotStopd t0: [15:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [15:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 16/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [15:00:00 16/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [15:00:00 16/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [15:00:00 16/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [15:00:00 16/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [15:00:00 16/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [15:00:00 16/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [15:00:00 16/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [15:00:00 16/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [15:00:00 16/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.7 u1: L/min st: NotStopd t0: [15:00:00 16/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [15:00:00 16/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [15:00:00 16/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 24 u1: . st: NotStopd t0: [15:00:00 16/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [15:00:00 16/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [15:00:00 16/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [15:00:00 16/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [15:00:00 16/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 320 u1: ml/B st: NotStopd t0: [15:00:00 16/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [15:00:00 16/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [16:00:00 16/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 16/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [16:00:00 16/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [16:00:00 16/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 16/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 16/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [16:00:00 16/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 16/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 16/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [16:00:00 16/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [16:00:00 16/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [16:00:00 16/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 30 st: NotStopd t0: [16:00:00 16/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 24 u1: . st: NotStopd t0: [16:00:00 16/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [16:00:00 16/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [16:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 98 u1: % st: NotStopd t0: [16:00:00 16/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [16:00:00 16/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:00:00 16/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [16:00:00 16/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 16/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [16:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 16/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 16/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 16/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 16/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 16/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 16/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 16/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 16/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 16/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 16/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 16/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 16/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 16/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 16/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [16:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 16/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 16/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 16/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 16/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 16/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 16/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 16/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 16/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 16/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 16/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 16/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 16/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 16/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 16/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 16/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 16/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [16:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79.3333 u1: mmHg st: NotStopd t0: [16:00:00 16/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 16/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 16/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 16/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 16/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 16/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 16/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 16/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [16:00:00 16/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 16/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [16:00:00 16/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 16/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 16/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 16/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 16/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 16/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 16/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [16:00:00 16/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [16:00:00 16/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [16:00:00 16/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 16/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 16/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 16/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 16/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 16/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 16/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 16/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 16/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 16/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Walks Occasional st: NotStopd t0: [16:00:00 16/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [16:00:00 16/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [16:00:00 16/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [16:00:00 16/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 16/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [16:00:00 16/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [16:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 2 cu: MICU cg: RN ai: -1 vo: 86 vu: ml st: Stopped
t0: [16:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml st: Restart
t0: [17:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [17:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [17:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 16/02/2016] tf: [10:30:00 18/02/2016] dt: 2490 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [18:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 16/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [18:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [18:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 16/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 16/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 16/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 16/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [18:00:00 16/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [18:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 16/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [18:00:00 16/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [17:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [17:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 68.3333 u1: mmHg st: NotStopd t0: [18:00:00 16/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 16/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd
t0: [20:00:00 16/02/2016] id: Cuff Leak el: 0 cu: MICU cg: 2827 v1: No st: NotStopd t0: [20:00:00 16/02/2016] id: FiO2 Set el: 0 cu: MICU cg: 2827 v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 16/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 16/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: 2827 v1: 50 u1: BPM st: NotStopd t0: [20:00:00 16/02/2016] id: Airway Size el: 0 cu: MICU cg: 2827 v1: 8.0 mm st: NotStopd t0: [20:00:00 16/02/2016] id: Airway Type el: 0 cu: MICU cg: 2827 v1: Tracheostomy st: NotStopd t0: [20:00:00 16/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: 2827 v1: 34.5 u1: Deg. C st: NotStopd t0: [20:00:00 16/02/2016] id: Intubation Date el: 0 cu: MICU cg: 2827 v1: 12 v2: 23 st: NotStopd t0: [20:00:00 16/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: 2827 v1: 5 st: NotStopd t0: [20:00:00 16/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: 2827 v1: 16 u1: cmH2O st: NotStopd t0: [20:00:00 16/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: 2827 v1: 11.6 u1: L/min st: NotStopd t0: [20:00:00 16/02/2016] id: PEEP Set el: 0 cu: MICU cg: 2827 v1: 10 u1: cmH2O st: NotStopd t0: [20:00:00 16/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: 2827 v1: 30 st: NotStopd t0: [20:00:00 16/02/2016] id: Pressure Support el: 0 cu: MICU cg: 2827 v1: 24 u1: . st: NotStopd t0: [20:00:00 16/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: 2827 v1: 31 u1: BPM st: NotStopd t0: [20:00:00 16/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: 2827 v1: 6 u1: cmH2O st: NotStopd t0: [20:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: 2827 v1: 99 u1: % st: NotStopd t0: [20:00:00 16/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: 2827 v1: 330 u1: ml/B st: NotStopd t0: [20:00:00 16/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: 2827 v1: Yes v2: No st: NotStopd t0: [20:00:00 16/02/2016] id: Trach Size el: 0 cu: MICU cg: 2827 v1: #8 st: NotStopd t0: [20:00:00 16/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: 2827 v1: Inflated st: NotStopd t0: [20:00:00 16/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: 2827 v1: Portex st: NotStopd t0: [20:00:00 16/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: 2827 v1: CPAP+PS st: NotStopd t0: [20:00:00 16/02/2016] id: Ventilator Type el: 0 cu: MICU cg: 2827 v1: Drager st: NotStopd
t0: [20:00:00 16/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 16/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 16/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 16/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 16/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 16/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 16/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 16/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 16/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 16/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 16/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 16/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 74 u1: BPM st: NotStopd t0: [20:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 16/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 16/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 16/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 16/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 16/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 16/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 16/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 16/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 16/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 16/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 16/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 16/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 16/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 16/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [20:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.3333 u1: mmHg st: NotStopd t0: [20:00:00 16/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Thrush st: NotStopd t0: [20:00:00 16/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 16/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 16/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [20:00:00 16/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 16/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [20:00:00 16/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 16/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 16/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 16/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 16/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 16/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [20:00:00 16/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 16/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [20:00:00 16/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 16/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 16/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 16/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 16/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 16/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 16/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
tf: [21:00:00 24/02/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Sulfameth/Trimethoprim DS v1: 1 u1: TAB
t0: [21:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [21:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [21:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 16/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [22:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [22:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 74.3333 u1: mmHg st: NotStopd t0: [22:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [22:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 16/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 16/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [20:00:00 16/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 16/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 16/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [22:00:00 16/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.6667 u1: Deg. C st: NotStopd t0: [22:00:00 16/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.8 u1: Deg. F st: NotStopd
t0: [00:00:00 17/02/2016] id: Cuff Leak el: 0 cu: MICU cg: 2827 v1: No st: NotStopd t0: [00:00:00 17/02/2016] id: FiO2 Set el: 0 cu: MICU cg: 2827 v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 17/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 17/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: 2827 v1: 50 u1: BPM st: NotStopd t0: [00:00:00 17/02/2016] id: Airway Size el: 0 cu: MICU cg: 2827 v1: 8.0 mm st: NotStopd t0: [00:00:00 17/02/2016] id: Airway Type el: 0 cu: MICU cg: 2827 v1: Tracheostomy st: NotStopd t0: [00:00:00 17/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: 2827 v1: 34.9 u1: Deg. C st: NotStopd t0: [00:00:00 17/02/2016] id: Intubation Date el: 0 cu: MICU cg: 2827 v1: 12 v2: 23 st: NotStopd t0: [00:00:00 17/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: 2827 v1: 5 st: NotStopd t0: [00:00:00 17/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: 2827 v1: 14 u1: cmH2O st: NotStopd t0: [00:00:00 17/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: 2827 v1: 8.7 u1: L/min st: NotStopd t0: [00:00:00 17/02/2016] id: PEEP Set el: 0 cu: MICU cg: 2827 v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 17/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: 2827 v1: 30 st: NotStopd t0: [00:00:00 17/02/2016] id: Pressure Support el: 0 cu: MICU cg: 2827 v1: 24 u1: . st: NotStopd t0: [00:00:00 17/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: 2827 v1: 30 u1: BPM st: NotStopd t0: [00:00:00 17/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: 2827 v1: 6 u1: cmH2O st: NotStopd t0: [00:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: 2827 v1: 99 u1: % st: NotStopd t0: [00:00:00 17/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: 2827 v1: 350 u1: ml/B st: NotStopd t0: [00:00:00 17/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: 2827 v1: Yes v2: No st: NotStopd t0: [00:00:00 17/02/2016] id: Trach Size el: 0 cu: MICU cg: 2827 v1: #8 st: NotStopd t0: [00:00:00 17/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: 2827 v1: Inflated st: NotStopd t0: [00:00:00 17/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: 2827 v1: Portex st: NotStopd t0: [00:00:00 17/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: 2827 v1: CPAP+PS st: NotStopd t0: [00:00:00 17/02/2016] id: Ventilator Type el: 0 cu: MICU cg: 2827 v1: Drager st: NotStopd
t0: [23:00:00 16/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 16/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 16/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 16/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 16/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 16/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [23:00:00 16/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 16/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [23:00:00 16/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 75.3333 u1: mmHg st: NotStopd t0: [23:00:00 16/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 16/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [23:00:00 16/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 16/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [00:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [00:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [00:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [00:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [23:00:00 16/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [23:00:00 16/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 17/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [01:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [01:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [01:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [01:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [01:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [02:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [02:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [23:00:00 17/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 17/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 17/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 370 ap: none t0: [23:00:00 17/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN cv: 2140 ap: none t0: [23:00:00 17/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 1440 ap: none t0: [23:00:00 17/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 1790 ap: none t0: [23:00:00 17/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN cv: 350 ap: carryForward t0: [23:00:00 17/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 1790 ap: carryForward t0: [23:00:00 17/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN cv: 5405.24 ap: carryForward
t0: [02:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [02:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 68.6667 u1: mmHg st: NotStopd t0: [03:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [03:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 113 u1: mmHg v2: 35 u2: mmHg st: NotStopd t0: [03:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 61 u1: mmHg st: NotStopd t0: [03:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [03:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [04:00:00 17/02/2016] id: RSBI (<100) el: 0 cu: MICU cg: 2827 v1: 176.19 u1: units st: NotStopd t0: [04:00:00 17/02/2016] id: Cuff Leak el: 0 cu: MICU cg: 2827 v1: Yes st: NotStopd t0: [04:00:00 17/02/2016] id: FiO2 Set el: 0 cu: MICU cg: 2827 v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 17/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: 2827 v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 17/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: 2827 v1: 50 u1: BPM st: NotStopd t0: [04:00:00 17/02/2016] id: Airway Size el: 0 cu: MICU cg: 2827 v1: 8.0 mm st: NotStopd t0: [04:00:00 17/02/2016] id: Airway Type el: 0 cu: MICU cg: 2827 v1: Tracheostomy st: NotStopd t0: [04:00:00 17/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: 2827 v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 17/02/2016] id: Intubation Date el: 0 cu: MICU cg: 2827 v1: 12 v2: 23 st: NotStopd t0: [04:00:00 17/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: 2827 v1: 5 st: NotStopd t0: [04:00:00 17/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: 2827 v1: 12 u1: cmH2O st: NotStopd t0: [04:00:00 17/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: 2827 v1: 9.68 u1: L/min st: NotStopd t0: [04:00:00 17/02/2016] id: PEEP Set el: 0 cu: MICU cg: 2827 v1: 8 u1: cmH2O st: NotStopd t0: [04:00:00 17/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: 2827 v1: 20 st: NotStopd t0: [04:00:00 17/02/2016] id: Pressure Support el: 0 cu: MICU cg: 2827 v1: 20 u1: . st: NotStopd t0: [04:00:00 17/02/2016] id: RSBI (<200) el: 0 cu: MICU cg: 2827 v1: 176.19 u1: units st: NotStopd t0: [04:00:00 17/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: 2827 v1: 30 u1: BPM st: NotStopd t0: [04:00:00 17/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: 2827 v1: 6 u1: cmH2O st: NotStopd t0: [04:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: 2827 v1: 100 u1: % st: NotStopd t0: [04:00:00 17/02/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: 2827 v1: 37 u1: BPM st: NotStopd t0: [04:00:00 17/02/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: 2827 v1: 0.21 u1: L st: NotStopd t0: [04:00:00 17/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: 2827 v1: 360 u1: ml/B st: NotStopd t0: [04:00:00 17/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: 2827 v1: Yes v2: No st: NotStopd t0: [04:00:00 17/02/2016] id: Trach Size el: 0 cu: MICU cg: 2827 v1: #8 st: NotStopd t0: [04:00:00 17/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: 2827 v1: Inflated st: NotStopd t0: [04:00:00 17/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: 2827 v1: Portex st: NotStopd t0: [04:00:00 17/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: 2827 v1: CPAP+PS st: NotStopd t0: [04:00:00 17/02/2016] id: Ventilator Type el: 0 cu: MICU cg: 2827 v1: Drager st: NotStopd
t0: [23:00:00 16/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [23:00:00 16/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 16/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [23:00:00 16/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [23:00:00 16/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [23:00:00 16/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [23:00:00 16/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [23:00:00 16/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [23:00:00 16/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [23:00:00 16/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [23:00:00 16/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 17/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 17/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 17/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 17/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 17/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 17/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 17/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 17/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 17/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 17/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [00:00:00 17/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 17/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 17/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Thrush st: NotStopd t0: [00:00:00 17/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 17/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [00:00:00 17/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 17/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 17/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 17/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 17/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [00:00:00 17/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 17/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 17/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 17/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 17/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [00:00:00 17/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 17/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 17/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [00:00:00 17/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 17/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [00:00:00 17/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [04:00:00 17/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 17/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 17/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 17/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 17/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 17/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [04:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 17/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 17/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 17/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 17/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 17/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 17/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 17/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [04:00:00 17/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 17/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 17/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 17/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 17/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [05:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [05:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 18 u1: BPM st: NotStopd t0: [05:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [06:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [06:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [06:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [06:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [06:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [04:00:00 17/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 17/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [04:00:00 17/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd
t0: [06:15:00 17/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 15.3 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 15.3 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 31.5 u1: % rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.1 u1: gm/dl rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 642 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.52 u1: /mic l rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 15.3 rs: Final st: NotStopd
t0: [06:15:00 17/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 15.3 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 15.3 rs: Final st: NotStopd
t0: [06:15:00 17/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 23 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 86 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 99 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 u1: mEq/L rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 23 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 37 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 86 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 99 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 u1: mEq/L rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 rs: Final st: NotStopd t0: [06:15:00 17/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd
t0: [08:00:00 17/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [08:00:00 17/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 17/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [08:00:00 17/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [08:00:00 17/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 17/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 17/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 17/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 17/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 17/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 17/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 17/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [08:00:00 17/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.8 u1: L/min st: NotStopd t0: [08:00:00 17/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [08:00:00 17/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 17/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [08:00:00 17/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [08:00:00 17/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [08:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:00:00 17/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 290 u1: ml/B st: NotStopd t0: [08:00:00 17/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:00:00 17/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:00:00 17/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [08:00:00 17/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:00:00 17/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [08:00:00 17/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [07:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [07:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [07:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [08:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [08:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [08:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [08:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [08:00:00 17/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 17/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [08:00:00 17/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 17/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 17/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:00:00 17/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 17/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 17/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 17/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 17/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 17/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [08:00:00 17/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 17/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 17/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 17/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [08:00:00 17/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 17/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 17/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 17/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 17/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 17/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 17/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 17/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 17/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 17/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 17/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 17/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [08:00:00 17/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 17/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 17/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 17/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 17/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 17/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 17/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 17/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 17/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [08:00:00 17/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 17/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 17/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:00:00 17/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 17/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 17/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 17/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 17/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [08:00:00 17/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 17/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 17/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [08:00:00 17/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [08:00:00 17/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 17/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 17/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 17/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 17/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 17/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 17/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 17/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 17/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Walks Occasional st: NotStopd t0: [08:00:00 17/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 17/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 17/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [08:00:00 17/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 17/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [08:00:00 17/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:00:00 17/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [08:00:00 17/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [09:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [09:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [09:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86.3333 u1: mmHg st: NotStopd t0: [09:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [09:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [10:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [10:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 17/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [10:00:00 17/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [10:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 17/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 100 vu: ml t0: [10:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [10:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [12:00:00 17/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [12:00:00 17/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 17/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [12:00:00 17/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [12:00:00 17/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 17/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 17/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 17/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 17/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 17/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 17/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 17/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [12:00:00 17/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [12:00:00 17/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [12:00:00 17/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 17/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [12:00:00 17/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [12:00:00 17/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [12:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:00:00 17/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [12:00:00 17/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [12:00:00 17/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 313 u1: ml/B st: NotStopd t0: [12:00:00 17/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:00:00 17/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:00:00 17/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [12:00:00 17/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:00:00 17/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:00:00 17/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [11:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [11:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [11:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.6667 u1: mmHg st: NotStopd t0: [11:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [11:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 17/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [11:00:00 17/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [11:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 17/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 17/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [12:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 17/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 17/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 17/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: Rare st: NotStopd t0: [12:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: PVC's st: NotStopd t0: [12:00:00 17/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 17/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 17/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 17/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [12:00:00 17/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 17/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 17/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [12:00:00 17/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 17/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [12:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 17/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 17/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 17/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 17/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 17/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 17/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 17/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 17/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [12:00:00 17/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 17/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 17/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 17/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [12:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 75.3333 u1: mmHg st: NotStopd t0: [12:00:00 17/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 17/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 17/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [12:00:00 17/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [12:00:00 17/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 17/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 17/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [12:00:00 17/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 17/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [12:00:00 17/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 17/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 17/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 17/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 17/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 17/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [12:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [12:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [12:00:00 17/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [12:00:00 17/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [12:00:00 17/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [12:00:00 17/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 17/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 17/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [12:00:00 17/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 17/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [12:00:00 17/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 17/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [12:00:00 17/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [12:00:00 17/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [13:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [13:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [13:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 17/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [14:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [14:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 17/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 17/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [14:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [14:00:00 17/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 17/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [14:00:00 17/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [14:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 17/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [14:00:00 17/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [14:00:00 17/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [14:00:00 17/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [15:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [15:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [15:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79.6667 u1: mmHg st: NotStopd t0: [15:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [15:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [15:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 17/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 17/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: RN v1: Pt Verbalized st: NotStopd t0: [16:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 17/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 17/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 17/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 17/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 17/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 17/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 17/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 17/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 17/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [16:00:00 17/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 17/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [16:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 17/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 17/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 17/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 17/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 17/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 17/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 17/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 17/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 17/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 17/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 17/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [16:00:00 17/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 17/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 17/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [16:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 75.3333 u1: mmHg st: NotStopd t0: [16:00:00 17/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 17/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 17/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [16:00:00 17/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 17/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [16:00:00 17/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 17/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 17/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 17/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Intact st: NotStopd t0: [16:00:00 17/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 17/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Fecal Incont Bag st: NotStopd t0: [16:00:00 17/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 17/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 17/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 17/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 17/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 17/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [14:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [14:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml t0: [16:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [16:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [15:55:00 17/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [15:55:00 17/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [15:55:00 17/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [15:55:00 17/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [15:55:00 17/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [15:55:00 17/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [15:55:00 17/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [15:55:00 17/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [15:55:00 17/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [15:55:00 17/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [15:55:00 17/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [15:55:00 17/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.9 u1: L/min st: NotStopd t0: [15:55:00 17/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [15:55:00 17/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [15:55:00 17/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [15:55:00 17/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [15:55:00 17/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [15:55:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [15:55:00 17/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [15:55:00 17/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [15:55:00 17/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 17/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 17/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 17/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 17/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [15:00:00 17/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [15:00:00 17/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [15:00:00 17/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [15:00:00 17/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 17/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [15:00:00 17/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [15:00:00 17/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [15:00:00 17/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [15:00:00 17/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [15:00:00 17/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [15:00:00 17/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 17/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 17/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 17/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 17/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [17:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 17/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 17/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [17:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [17:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 17/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [17:00:00 17/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [17:00:00 17/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Normal Saline st: NotStopd t0: [17:00:00 17/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [17:00:00 17/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serosanguinous v2: Small st: NotStopd t0: [17:00:00 17/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [17:00:00 17/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [17:00:00 17/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [17:00:00 17/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [17:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [17:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 76.6667 u1: mmHg st: NotStopd t0: [17:00:00 17/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 17/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [17:00:00 17/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [17:00:00 17/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [17:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [17:00:00 17/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 17/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [17:00:00 17/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 17/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [17:00:00 17/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [17:00:00 17/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [17:00:00 17/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [17:00:00 17/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.1667 u1: Deg. C st: NotStopd t0: [17:00:00 17/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.1 u1: Deg. F st: NotStopd t0: [17:00:00 17/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [17:00:00 17/02/2016] id: Trach Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 17/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [17:00:00 17/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [17:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [17:00:00 17/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: Done t0: [18:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [18:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [18:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [18:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [18:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [18:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [19:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 17/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [19:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 17/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [19:00:00 17/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [19:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [19:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [19:00:00 17/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [19:00:00 17/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [19:00:00 17/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [19:00:00 17/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [19:00:00 17/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [19:00:00 17/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [19:00:00 17/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [19:00:00 17/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [18:00:00 17/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 100 vu: ml t0: [19:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [19:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [19:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [19:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [19:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [19:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 17/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 330 ap: none
t0: [23:00:00 17/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [20:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd
t0: [20:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [20:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [20:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86.3333 u1: mmHg st: NotStopd t0: [20:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [20:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [20:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [20:45:00 17/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:45:00 17/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:45:00 17/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:45:00 17/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [20:45:00 17/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:45:00 17/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:45:00 17/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:45:00 17/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:45:00 17/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:45:00 17/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:45:00 17/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:45:00 17/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [20:45:00 17/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.5 u1: L/min st: NotStopd t0: [20:45:00 17/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:45:00 17/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:45:00 17/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [20:45:00 17/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [20:45:00 17/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [20:45:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [20:45:00 17/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 280 u1: ml/B st: NotStopd t0: [20:45:00 17/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:45:00 17/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:45:00 17/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:45:00 17/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:45:00 17/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:45:00 17/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [21:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [21:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 71.6667 u1: mmHg st: NotStopd t0: [21:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [21:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 17/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 17/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [20:00:00 17/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 17/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 17/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 17/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 17/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 17/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [20:00:00 17/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 17/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 17/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 17/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 17/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Crackles st: NotStopd t0: [20:00:00 17/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 17/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 17/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 17/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 17/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 17/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [20:00:00 17/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [20:00:00 17/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 17/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 17/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 17/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 17/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 17/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [22:00:00 17/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [22:00:00 17/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [22:00:00 17/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [22:00:00 17/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [22:00:00 17/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [22:00:00 17/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [22:00:00 17/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [22:00:00 17/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd
t0: [00:20:00 18/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:20:00 18/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:20:00 18/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:20:00 18/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [00:20:00 18/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:20:00 18/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:20:00 18/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:20:00 18/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:20:00 18/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:20:00 18/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:20:00 18/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:20:00 18/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [00:20:00 18/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.3 u1: L/min st: NotStopd t0: [00:20:00 18/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:20:00 18/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:20:00 18/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [00:20:00 18/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [00:20:00 18/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [00:20:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:20:00 18/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [00:20:00 18/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:20:00 18/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:20:00 18/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:20:00 18/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:20:00 18/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:20:00 18/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [23:00:00 17/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 17/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 17/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 17/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 17/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 17/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [23:00:00 17/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 17/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 57 u2: mmHg st: NotStopd t0: [23:00:00 17/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 72.6667 u1: mmHg st: NotStopd t0: [23:00:00 17/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 17/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [23:00:00 17/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [23:00:00 17/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 18/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 18/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 18/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 18/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [00:00:00 18/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [00:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 18/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 18/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 18/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 18/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 18/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 18/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 18/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 18/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 18/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [00:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 18/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [00:00:00 18/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 18/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 18/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 18/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 18/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 18/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [00:00:00 18/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 18/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 18/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [00:00:00 18/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 18/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 18/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 18/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 18/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 18/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 18/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [00:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 71.6667 u1: mmHg st: NotStopd t0: [00:00:00 18/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 18/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 18/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 18/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 18/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 18/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 18/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [00:00:00 18/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [00:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 18/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 18/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 18/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [00:00:00 18/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [00:00:00 18/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 18/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 18/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 18/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [00:00:00 18/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [00:00:00 18/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [00:00:00 18/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 18/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 18/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [00:00:00 18/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [00:00:00 18/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 18/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 18/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 18/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 18/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 18/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 18/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [00:00:00 18/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 18/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 18/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 18/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 18/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [00:00:00 18/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [00:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [00:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [01:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [01:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 126 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [01:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86.6667 u1: mmHg st: NotStopd t0: [01:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [01:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [01:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [02:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [02:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79.3333 u1: mmHg st: NotStopd t0: [02:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [02:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [02:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [02:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [03:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [03:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [03:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [03:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [03:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [03:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [23:00:00 18/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 30 cv: 30 ap: none t0: [23:00:00 18/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 35 cv: 35 ap: none t0: [23:00:00 18/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 5 cv: 616.7 ap: none t0: [23:00:00 18/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 65 cv: 2166.7 ap: none t0: [23:00:00 18/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 60 cv: 1280 ap: none t0: [23:00:00 18/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 30 cv: 1510 ap: none t0: [23:00:00 18/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 35 cv: 656.7 ap: carryForward t0: [23:00:00 18/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 30 cv: 1510 ap: carryForward t0: [23:00:00 18/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 35 cv: 6061.94 ap: carryForward
t0: [04:40:00 18/02/2016] id: RSBI (<100) el: 0 cu: MICU cg: RRT v1: 172 u1: units st: NotStopd t0: [04:40:00 18/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:40:00 18/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:40:00 18/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:40:00 18/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [04:40:00 18/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:40:00 18/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:40:00 18/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:40:00 18/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:40:00 18/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [04:40:00 18/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:40:00 18/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:40:00 18/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [04:40:00 18/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [04:40:00 18/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:40:00 18/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:40:00 18/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [04:40:00 18/02/2016] id: RSBI (<200) el: 0 cu: MICU cg: RRT v1: 172 u1: units st: NotStopd t0: [04:40:00 18/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [04:40:00 18/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [04:40:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [04:40:00 18/02/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 43 u1: BPM st: NotStopd t0: [04:40:00 18/02/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.25 u1: L st: NotStopd t0: [04:40:00 18/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 300 u1: ml/B st: NotStopd t0: [04:40:00 18/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:40:00 18/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:40:00 18/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:40:00 18/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:40:00 18/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:40:00 18/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [04:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [04:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [04:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 80.3333 u1: mmHg st: NotStopd t0: [04:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [04:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [05:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [05:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.3333 u1: mmHg st: NotStopd t0: [05:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [05:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [05:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 18/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [04:00:00 18/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 18/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [04:00:00 18/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 18/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 18/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 18/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 18/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 18/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [04:00:00 18/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 18/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 18/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 18/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 18/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [04:00:00 18/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [04:00:00 18/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 18/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 18/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 18/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 18/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 18/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 18/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 18/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [04:00:00 18/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [04:00:00 18/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [04:00:00 18/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [04:00:00 18/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 18/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [04:00:00 18/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 18/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 18/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Bloody v2: Thick st: NotStopd t0: [04:00:00 18/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [04:00:00 18/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 18/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 18/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [04:00:00 18/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 18/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 18/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [04:00:00 18/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [05:00:00 18/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [05:00:00 18/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 18/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [05:00:00 18/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 18/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 18/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [05:00:00 18/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 18/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 18/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [05:00:00 18/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 18/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 18/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done
t0: [05:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [05:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [05:00:00 18/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [05:00:00 18/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.1111 u1: Deg. C st: NotStopd t0: [05:00:00 18/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97 u1: Deg. F st: NotStopd
t0: [04:30:00 18/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 11.9 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 11.9 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 32 u1: % rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10 u1: gm/dl rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 569 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.53 u1: /mic l rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 11.9 rs: Final st: NotStopd
t0: [04:30:00 18/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 15.2 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 32.6 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 15.2 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 32.6 rs: Final st: NotStopd
t0: [04:30:00 18/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 25 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 9 u1: mg/dl rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 86 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 97 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 130 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 25 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 9 u1: mg/dl rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 37 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 86 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 97 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.1 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.6 rs: Final st: NotStopd t0: [04:30:00 18/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 130 rs: Final st: NotStopd
t0: [06:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [06:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [06:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 18/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 18/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [08:00:00 18/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [08:00:00 18/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:00:00 18/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:00:00 18/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 18/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:00:00 18/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:00:00 18/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [08:00:00 18/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.3 u1: L/min st: NotStopd t0: [08:00:00 18/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [08:00:00 18/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:00:00 18/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [08:00:00 18/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [08:00:00 18/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [08:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [08:00:00 18/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 339 u1: ml/B st: NotStopd t0: [08:00:00 18/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [08:00:00 18/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [08:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [08:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [08:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [08:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [08:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 18/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [08:00:00 18/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd
t0: [08:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 15 vu: ml t0: [08:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 180 vu: ml
t0: [09:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [09:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [09:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [09:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [09:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [09:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 18/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [09:00:00 18/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [09:00:00 18/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [09:00:00 18/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [09:00:00 18/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 18/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [09:00:00 18/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [09:00:00 18/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [09:00:00 18/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [09:00:00 18/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [09:00:00 18/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [09:00:00 18/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [09:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 18/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [09:00:00 18/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [09:00:00 18/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [09:00:00 18/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [09:00:00 18/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [09:00:00 18/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 18/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [09:00:00 18/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [09:00:00 18/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [09:00:00 18/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 18/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [09:00:00 18/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [09:00:00 18/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [09:00:00 18/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [09:00:00 18/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 18/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 18/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [09:00:00 18/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [09:00:00 18/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [09:00:00 18/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [09:00:00 18/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [09:00:00 18/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [09:00:00 18/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [09:00:00 18/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [09:00:00 18/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [09:00:00 18/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [09:00:00 18/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [09:00:00 18/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [09:00:00 18/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [09:00:00 18/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [09:00:00 18/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 18/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 18/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [09:00:00 18/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [09:00:00 18/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 18/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [09:00:00 18/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [09:00:00 18/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [09:00:00 18/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [09:00:00 18/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [09:00:00 18/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Hypoactive st: NotStopd t0: [09:00:00 18/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [09:00:00 18/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [09:00:00 18/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [09:00:00 18/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [09:00:00 18/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [09:00:00 18/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 17 u1: number st: NotStopd t0: [09:00:00 18/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd
t0: [09:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [10:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 2 cu: MICU cg: -1 ai: -1 vo: 0 st: D/C'd
tf: [10:00:00 18/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 10 dn: 1 m1: Potassium Phosphate v1: 30 u1: mmol m2: D5W v2: 250 u2: ml tf: [09:00:00 19/02/2016] pt: Unit Dose rt: PO fr: ONCE fs: 10 dn: 1 m1: Potassium Chloride v1: 40 u1: mEq tf: [10:00:00 22/02/2016] pt: Unit Dose rt: PO fr: QD fs: 10 dn: 1 m1: Warfarin v1: 1 u1: mg
t0: [10:30:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:30:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:30:00 18/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:30:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:30:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:30:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:30:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [10:30:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:30:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [10:30:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.6667 u1: mmHg st: NotStopd t0: [10:30:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:30:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [10:30:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:30:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:30:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 7.5 vu: ml t0: [10:30:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml
tf: [10:00:00 19/02/2016] pt: IV Piggyback rt: IV fr: ONCE fs: 11 dn: 1 m1: Potassium Phosphate v1: 30 u1: mmol m2: NS v2: 250 u2: ml tf: [21:00:00 26/02/2016] pt: Unit Dose rt: PO fr: BID:PRN m1: Docusate Sodium (Liquid) v1: 100 u1: mg
t0: [11:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [11:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml
t0: [12:00:00 18/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 18/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [12:00:00 18/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [12:00:00 18/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:00:00 18/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:00:00 18/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 18/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:00:00 18/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:00:00 18/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [12:00:00 18/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.1 u1: L/min st: NotStopd t0: [12:00:00 18/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [12:00:00 18/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:00:00 18/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [12:00:00 18/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [12:00:00 18/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [12:00:00 18/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 353 u1: ml/B st: NotStopd t0: [12:00:00 18/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:00:00 18/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [11:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [12:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 18/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 18/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 18/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 18/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 18/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 18/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 18/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [12:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 18/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [12:00:00 18/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 18/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [12:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [12:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 18/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [12:00:00 18/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 18/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 18/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 18/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 18/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [12:00:00 18/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [12:00:00 18/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [12:00:00 18/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 7.5 vu: ml t0: [12:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml
t0: [12:00:00 18/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 18/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 18/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [12:00:00 18/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd
id: Potassium Phosphate el: 300 cu: MICU cg: RN io: D5W IV Infusions am: 30 du: mEq rt: Intravenous Push
io: D5W IV Infusions el: 3 cu: MICU cg: RN ra: 41.7 ru: ml/hr
id: D5W el: 3 cu: MICU cg: RN io: D5W IV Infusions du: ml rt: Intravenous Push
t0: [13:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [13:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 80 u2: mmHg st: NotStopd t0: [13:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104.667 u1: mmHg st: NotStopd t0: [13:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [13:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 18/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 120 vu: ml t0: [13:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [13:00:00 18/02/2016] tf: [09:30:00 19/02/2016] dt: 1230 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [23:00:00 18/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 270 ap: none
t0: [13:00:00 18/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [13:00:00 18/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [14:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 18/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 18/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [14:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 18/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [14:00:00 18/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [14:00:00 18/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [14:00:00 18/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [14:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [14:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 18/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 18/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [14:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [14:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [14:00:00 18/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 18/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 18/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 18/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [14:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [14:00:00 18/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 18/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [14:00:00 18/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [14:00:00 18/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [14:00:00 18/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [14:00:00 18/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [14:00:00 18/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 18/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [14:00:00 18/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 18/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 18/02/2016] id: D5W IV Infusions el: 3 cu: MICU cg: RN ai: 168 vo: 0 vu: ml nb: 1 t0: [14:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [14:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 45 vu: ml
t0: [15:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 18/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [15:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [15:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86.3333 u1: mmHg st: NotStopd t0: [15:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [15:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [15:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 45 vu: ml
t0: [16:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 18/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 18/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [16:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 18/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [16:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 18/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 18/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 18/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 18/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 18/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 18/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [16:00:00 18/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 18/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 18/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [16:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 18/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 18/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 18/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 18/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 18/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 18/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 18/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 18/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Wound Cleanser st: NotStopd t0: [16:00:00 18/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 18/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 18/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 18/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [16:00:00 18/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 18/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 18/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 18/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 18/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 18/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 18/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 18/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 18/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [16:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.3333 u1: mmHg st: NotStopd t0: [16:00:00 18/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 18/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 18/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 18/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 18/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 18/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 18/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [16:00:00 18/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [16:00:00 18/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 18/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 18/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 18/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 18/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 18/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [16:00:00 18/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 18/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [16:00:00 18/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 18/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 18/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [16:00:00 18/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [16:00:00 18/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 18/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 18/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [16:00:00 18/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 18/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 18/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 18/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [16:00:00 18/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [16:00:00 18/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 18/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [16:00:00 18/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [16:00:00 18/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [16:00:00 18/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [16:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [16:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 45 vu: ml
t0: [23:00:00 18/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [16:00:00 18/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 18/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [16:00:00 18/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [16:00:00 18/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 18/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 18/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [16:00:00 18/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 18/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 18/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 18/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 18/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [16:00:00 18/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.1 u1: L/min st: NotStopd t0: [16:00:00 18/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [16:00:00 18/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 18/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [16:00:00 18/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [16:00:00 18/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [16:00:00 18/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [16:00:00 18/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [16:00:00 18/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [16:00:00 18/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:00:00 18/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [17:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [17:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [17:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.3333 u1: mmHg st: NotStopd t0: [17:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [17:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 18/02/2016] tf: [18:00:00 18/02/2016] dt: 60 id: D5W IV Infusions el: 3 cu: MICU cg: RN ai: 168 vo: 200 vu: ml t0: [17:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [17:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 110 vu: ml
t0: [18:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 18/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [18:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [18:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99.6667 u1: mmHg st: NotStopd t0: [18:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 25 u1: BPM st: NotStopd t0: [18:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [18:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 45 vu: ml
t0: [18:30:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:30:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:30:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:30:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [18:30:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:30:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [18:30:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:30:00 18/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [18:30:00 18/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [18:30:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 18/02/2016] id: D5W IV Infusions el: 3 cu: MICU cg: -1 ai: 168 vo: 0 st: D/C'd
t0: [20:00:00 18/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 18/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 18/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 18/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [20:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 18/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [20:00:00 18/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 18/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 18/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 18/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 18/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 18/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 18/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 18/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [20:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [20:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 18/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 18/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 18/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 18/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 18/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 18/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 18/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [20:00:00 18/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 18/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 18/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 18/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 18/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 18/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 18/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 18/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 18/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 18/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 18/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [20:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.3333 u1: mmHg st: NotStopd t0: [20:00:00 18/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 18/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 18/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 18/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 18/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [20:00:00 18/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [20:00:00 18/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 18/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 18/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 18/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [20:00:00 18/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [20:00:00 18/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 18/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 18/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 18/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 18/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 18/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [20:00:00 18/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 18/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [20:00:00 18/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [20:00:00 18/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 18/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 18/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.3333 u1: Deg. C st: NotStopd t0: [20:00:00 18/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.2 u1: Deg. F st: NotStopd t0: [20:00:00 18/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 18/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 18/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 18/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 18/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 18/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 18/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 18/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Bedfast st: NotStopd t0: [20:00:00 18/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [20:00:00 18/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [20:00:00 18/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [20:00:00 18/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 18/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 14 u1: number st: NotStopd t0: [20:00:00 18/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [18:00:00 18/02/2016] id: D5W IV Infusions el: 3 cu: MICU cg: RN ai: 168 vo: 41.7 vu: ml st: Stopped t0: [20:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 90 vu: ml
t0: [20:30:00 18/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:30:00 18/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:30:00 18/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:30:00 18/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [20:30:00 18/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [20:30:00 18/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:30:00 18/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:30:00 18/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34 u1: Deg. C st: NotStopd t0: [20:30:00 18/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:30:00 18/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [20:30:00 18/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:30:00 18/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:30:00 18/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [20:30:00 18/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10 u1: L/min st: NotStopd t0: [20:30:00 18/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:30:00 18/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:30:00 18/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [20:30:00 18/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [20:30:00 18/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [20:30:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:30:00 18/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 350 u1: ml/B st: NotStopd t0: [20:30:00 18/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:30:00 18/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:30:00 18/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:30:00 18/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:30:00 18/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:30:00 18/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [22:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [22:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [22:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.6667 u1: mmHg st: NotStopd t0: [22:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [22:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [22:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [23:00:00 18/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 18/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 18/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 18/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 18/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 18/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [23:00:00 18/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [23:00:00 18/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 18/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [23:00:00 18/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [23:00:00 18/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [23:00:00 18/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.6667 u1: mmHg st: NotStopd t0: [23:00:00 18/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [23:00:00 18/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [23:00:00 18/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [23:00:00 18/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 18/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [23:00:00 18/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 18/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thin st: NotStopd t0: [23:00:00 18/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [23:00:00 18/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [23:00:00 18/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [23:00:00 18/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 18/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 18/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [23:00:00 18/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [23:00:00 18/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [23:00:00 18/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [23:00:00 18/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [23:00:00 18/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [23:00:00 18/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [23:00:00 18/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [23:00:00 18/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [23:00:00 18/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [23:00:00 18/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [23:00:00 18/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [23:00:00 18/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [23:00:00 18/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [23:00:00 18/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [23:00:00 18/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [23:00:00 18/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [23:00:00 18/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [23:00:00 18/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [23:00:00 18/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [23:00:00 18/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [23:00:00 18/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [23:00:00 18/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [23:00:00 18/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [23:00:00 18/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [23:00:00 18/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [23:00:00 18/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 18/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [23:00:00 18/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [23:00:00 18/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [23:00:00 18/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [23:00:00 18/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [23:00:00 18/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [23:00:00 18/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [23:00:00 18/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [00:00:00 19/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 19/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 19/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 19/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [00:00:00 19/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [00:00:00 19/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 19/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 19/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 19/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 19/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 19/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 19/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 19/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [00:00:00 19/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.2 u1: L/min st: NotStopd t0: [00:00:00 19/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:00:00 19/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 19/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [00:00:00 19/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [00:00:00 19/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 6 u1: cmH2O st: NotStopd t0: [00:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 19/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 341 u1: ml/B st: NotStopd t0: [00:00:00 19/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 19/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 19/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 19/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 19/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 19/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [23:00:00 18/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [23:00:00 18/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [23:00:00 18/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [00:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [00:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [00:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [01:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [01:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.6667 u1: mmHg st: NotStopd t0: [01:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [01:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [01:00:00 19/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [01:00:00 19/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [01:00:00 19/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [02:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [02:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [02:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.6667 u1: mmHg st: NotStopd t0: [02:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [02:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 19/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [23:00:00 19/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 60 cv: 60 ap: none t0: [23:00:00 19/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -15 cv: -15 ap: none t0: [23:00:00 19/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 5 cv: 120 ap: none t0: [23:00:00 19/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 45 cv: 1810 ap: none t0: [23:00:00 19/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 40 cv: 690 ap: none t0: [23:00:00 19/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 60 cv: 1545 ap: none t0: [23:00:00 19/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -15 cv: 265 ap: carryForward t0: [23:00:00 19/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 60 cv: 1545 ap: carryForward t0: [23:00:00 19/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -15 cv: 6326.94 ap: carryForward
t0: [03:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [03:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 112 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [03:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 76.6667 u1: mmHg st: NotStopd t0: [03:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [03:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 19/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 19/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 19/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 19/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [04:00:00 19/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [04:00:00 19/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 19/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 19/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 19/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 19/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [04:00:00 19/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 19/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 19/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [04:00:00 19/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [04:00:00 19/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:00:00 19/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 19/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [04:00:00 19/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [04:00:00 19/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:00:00 19/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Bloody v2: Thick st: NotStopd t0: [04:00:00 19/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Scant st: NotStopd t0: [04:00:00 19/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 342 u1: ml/B st: NotStopd t0: [04:00:00 19/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 19/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 19/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 19/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 19/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:00:00 19/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [04:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [04:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 22 u1: BPM st: NotStopd t0: [04:00:00 19/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.9444 u1: Deg. C st: NotStopd t0: [04:00:00 19/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.5 u1: Deg. F st: NotStopd t0: [04:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 19/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [05:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 19/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [05:00:00 19/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [05:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [05:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 133 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [05:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.3333 u1: mmHg st: NotStopd t0: [05:00:00 19/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [05:00:00 19/02/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 23 u1: BPM st: NotStopd t0: [05:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 19/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [05:00:00 19/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [05:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [04:00:00 19/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml t0: [05:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 19/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [04:00:00 19/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [04:00:00 19/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [05:00:00 19/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [05:00:00 19/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [05:00:00 19/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [05:00:00 19/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [05:00:00 19/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [05:00:00 19/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [05:00:00 19/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [05:00:00 19/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [05:00:00 19/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [05:00:00 19/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 19/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [05:00:00 19/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [05:00:00 19/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [05:00:00 19/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [05:00:00 19/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [05:00:00 19/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 19/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [05:00:00 19/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [05:00:00 19/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [05:00:00 19/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [05:00:00 19/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 19/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 19/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [05:00:00 19/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 19/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 19/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [05:00:00 19/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [05:00:00 19/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [05:00:00 19/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [05:00:00 19/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [05:00:00 19/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [05:00:00 19/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [05:00:00 19/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [05:00:00 19/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [05:00:00 19/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [05:00:00 19/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [05:00:00 19/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [05:00:00 19/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 19/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [05:00:00 19/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [05:00:00 19/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Liquid st: NotStopd t0: [05:00:00 19/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [05:00:00 19/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [05:00:00 19/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [05:00:00 19/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 19/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [05:00:00 19/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [05:00:00 19/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [05:00:00 19/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 19/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [05:18:00 19/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.4 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 13.4 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 31.3 u1: % rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.1 u1: gm/dl rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 554 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.48 u1: /mic l rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.4 rs: Final st: NotStopd
t0: [05:18:00 19/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 90 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 99 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.2 u1: mEq/L rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.4 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: 7 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 18 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 187 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.2 u1: mg/dl rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 34 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 90 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 99 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.2 u1: mEq/L rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.4 rs: Final st: NotStopd
t0: [05:18:00 19/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 15.3 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 32.5 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.6 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 15.3 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 32.5 rs: Final st: NotStopd
t0: [06:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [06:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [06:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 19/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 60 vu: ml
t0: [06:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 157 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [06:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100.333 u1: mmHg st: NotStopd
t0: [08:30:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:30:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:30:00 19/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:30:00 19/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [08:30:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:30:00 19/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [08:30:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:30:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:30:00 19/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:30:00 19/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:30:00 19/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:30:00 19/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:30:00 19/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:30:00 19/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:30:00 19/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:30:00 19/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:30:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [08:30:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:30:00 19/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:30:00 19/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:30:00 19/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:30:00 19/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:30:00 19/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:30:00 19/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:30:00 19/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:30:00 19/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [08:30:00 19/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [08:30:00 19/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:30:00 19/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:30:00 19/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [08:30:00 19/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:30:00 19/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:30:00 19/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:30:00 19/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:30:00 19/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:30:00 19/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:30:00 19/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:30:00 19/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:30:00 19/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:30:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 154 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [08:30:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.6667 u1: mmHg st: NotStopd t0: [08:30:00 19/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:30:00 19/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:30:00 19/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:30:00 19/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:30:00 19/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:30:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:30:00 19/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:30:00 19/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:30:00 19/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:30:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [08:30:00 19/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [08:30:00 19/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:30:00 19/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:30:00 19/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:30:00 19/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:30:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:30:00 19/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [08:30:00 19/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [08:30:00 19/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Loose st: NotStopd t0: [08:30:00 19/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Mushroom Cath st: NotStopd t0: [08:30:00 19/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:30:00 19/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:30:00 19/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [08:30:00 19/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [08:30:00 19/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:30:00 19/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:30:00 19/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Sediment st: NotStopd t0: [08:30:00 19/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:30:00 19/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:30:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:30:00 19/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:30:00 19/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [08:30:00 19/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:30:00 19/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:30:00 19/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [08:30:00 19/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:30:00 19/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [08:30:00 19/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:30:00 19/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 200 vu: ml t0: [08:30:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 12.5 vu: ml t0: [08:30:00 19/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 150 vu: ml
t0: [08:35:00 19/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [08:35:00 19/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [08:35:00 19/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [08:35:00 19/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [08:35:00 19/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [08:35:00 19/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [08:35:00 19/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [08:35:00 19/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [08:35:00 19/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [08:35:00 19/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [08:35:00 19/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [08:35:00 19/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [08:35:00 19/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.1 u1: L/min st: NotStopd t0: [08:35:00 19/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [08:35:00 19/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [08:35:00 19/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 18 u1: . st: NotStopd t0: [08:35:00 19/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [08:35:00 19/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [08:35:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [08:35:00 19/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 274 u1: ml/B st: NotStopd t0: [08:35:00 19/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [08:35:00 19/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [08:35:00 19/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [08:35:00 19/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [08:35:00 19/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [09:30:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:30:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:30:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:30:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:30:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [09:30:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:30:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:30:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [09:30:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:30:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:30:00 19/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 120 vu: ml t0: [09:30:00 19/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml
t0: [05:18:00 19/02/2016] id: Albumin Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 rs: Final st: NotStopd t0: [05:18:00 19/02/2016] id: Albumin (>3.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 rs: Final st: NotStopd
t0: [11:05:00 19/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [11:05:00 19/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Scant st: NotStopd
t0: [12:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 19/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 19/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Tube Feeding st: NotStopd t0: [12:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 19/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 19/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 19/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 19/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 19/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [12:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 19/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [12:00:00 19/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 19/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 19/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [12:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [12:00:00 19/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 19/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [12:00:00 19/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [12:00:00 19/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [12:00:00 19/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 17.5 vu: ml
t0: [12:15:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:15:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:15:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:15:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:15:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:15:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [12:15:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:15:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 192 u1: mmHg v2: 91 u2: mmHg st: NotStopd t0: [12:15:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 124.667 u1: mmHg st: NotStopd t0: [12:15:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:15:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [12:15:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:15:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 19/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [12:00:00 19/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [12:30:00 19/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:30:00 19/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:30:00 19/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [12:30:00 19/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [12:30:00 19/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:30:00 19/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:30:00 19/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:30:00 19/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:30:00 19/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:30:00 19/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:30:00 19/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [12:30:00 19/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [12:30:00 19/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.32 u1: L/min st: NotStopd t0: [12:30:00 19/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [12:30:00 19/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:30:00 19/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [12:30:00 19/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [12:30:00 19/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:30:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:30:00 19/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 270 u1: ml/B st: NotStopd t0: [12:30:00 19/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:30:00 19/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:30:00 19/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:30:00 19/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:30:00 19/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [14:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 19/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 19/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [14:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 19/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [14:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 19/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [14:00:00 19/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [14:00:00 19/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [14:00:00 19/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [14:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [14:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 19/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 19/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 19/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [14:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [14:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95 u1: mmHg st: NotStopd t0: [14:00:00 19/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 19/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 19/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 19/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [14:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 17 u1: BPM st: NotStopd t0: [14:00:00 19/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 19/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [14:00:00 19/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 19/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [14:00:00 19/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 19/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 200 vu: ml t0: [14:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [23:00:00 19/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [15:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [15:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 140 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [15:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [15:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [15:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml
t0: [16:00:00 19/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:00:00 19/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 19/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [16:00:00 19/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [16:00:00 19/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 19/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 19/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 19/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 19/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:00:00 19/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 19/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 19/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [16:00:00 19/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.5 u1: L/min st: NotStopd t0: [16:00:00 19/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [16:00:00 19/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 19/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [16:00:00 19/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [16:00:00 19/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [16:00:00 19/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Bloody v2: Thick st: NotStopd t0: [16:00:00 19/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [16:00:00 19/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 267 u1: ml/B st: NotStopd t0: [16:00:00 19/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:00:00 19/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:00:00 19/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:00:00 19/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:00:00 19/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [16:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 19/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 19/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [16:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 19/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [16:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 19/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 19/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 19/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 19/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 19/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 19/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 19/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 19/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 19/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [16:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 19/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 19/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 19/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 19/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 19/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 19/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [16:00:00 19/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 19/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 19/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 19/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [16:00:00 19/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 19/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 19/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 19/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 19/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 19/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 19/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 19/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 19/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 19/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 19/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 19/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 19/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 19/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 19/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [16:00:00 19/02/2016] id: Responds to Stimuli el: 0 cu: MICU cg: RN v1: Verbal v2: Localizes st: NotStopd t0: [16:00:00 19/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 19/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 19/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 19/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 19/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Formed st: NotStopd t0: [16:00:00 19/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 19/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 19/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [16:00:00 19/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [16:00:00 19/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 19/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Cloudy st: NotStopd t0: [16:00:00 19/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 19/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 19/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 19/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 19/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [16:00:00 19/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [16:00:00 19/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 19/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [16:00:00 19/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [16:00:00 19/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 17 u1: number st: NotStopd t0: [16:00:00 19/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd
t0: [16:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml
t0: [16:00:00 19/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 200 vu: ml
t0: [18:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 19/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 19/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [18:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [18:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 19/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [18:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.6667 u1: mmHg st: NotStopd t0: [18:00:00 19/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [18:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [18:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 96 u1: % st: NotStopd t0: [18:00:00 19/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [18:00:00 19/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [18:00:00 19/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [18:00:00 19/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [18:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 19/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 180 vu: ml t0: [18:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [23:00:00 19/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 1000 ap: none
t0: [18:30:00 19/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [18:30:00 19/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd
t0: [19:00:00 19/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: SocServ Involved st: NotStopd t0: [20:00:00 19/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 19/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 19/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [20:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 19/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [20:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 19/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 19/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 19/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 19/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 19/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 19/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 19/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 19/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [20:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 19/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 19/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 19/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 19/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 19/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 19/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 19/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 19/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 19/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 19/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None v2: Scant st: NotStopd t0: [20:00:00 19/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 19/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 19/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [20:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.3333 u1: mmHg st: NotStopd t0: [20:00:00 19/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 19/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 19/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 19/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [20:00:00 19/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 19/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 19/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 19/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 19/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 19/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Cloudy st: NotStopd t0: [20:00:00 19/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 19/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 19/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 19/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [21:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [21:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [21:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103.333 u1: mmHg st: NotStopd t0: [21:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [21:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml
t0: [21:00:00 19/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [21:00:00 19/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [21:00:00 19/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd
t0: [20:00:00 19/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 19/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 19/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 19/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [21:00:00 19/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Undigested Food st: NotStopd t0: [21:00:00 19/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 19/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 19/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 19/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 19/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 19/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 19/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 19/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 19/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
t0: [21:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 19/02/2016] tf: [12:00:00 20/02/2016] dt: 900 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml nb: 1
t0: [21:00:00 19/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [21:00:00 19/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [21:00:00 19/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [21:00:00 19/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [21:00:00 19/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [21:00:00 19/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [21:00:00 19/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [21:00:00 19/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [21:00:00 19/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [21:00:00 19/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [21:00:00 19/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [21:00:00 19/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.3 u1: L/min st: NotStopd t0: [21:00:00 19/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [21:00:00 19/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [21:00:00 19/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [21:00:00 19/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [21:00:00 19/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [21:00:00 19/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 298 u1: ml/B st: NotStopd t0: [21:00:00 19/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [21:00:00 19/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [21:00:00 19/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [21:00:00 19/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [21:00:00 19/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [21:00:00 19/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [22:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 19/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [22:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [22:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.6667 u1: mmHg st: NotStopd t0: [22:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 39 u1: BPM st: NotStopd t0: [22:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 19/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [23:00:00 19/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 19/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 19/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 19/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 19/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 19/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [23:00:00 19/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 19/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 104 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [23:00:00 19/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 72 u1: mmHg st: NotStopd t0: [23:00:00 19/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 19/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [23:00:00 19/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [23:00:00 19/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 19/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 19/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [00:00:00 20/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 20/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 20/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 20/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 35 u1: cmH2O st: NotStopd t0: [00:00:00 20/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [00:00:00 20/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 20/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 20/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 20/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 20/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 20/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 20/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 20/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [00:00:00 20/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.8 u1: L/min st: NotStopd t0: [00:00:00 20/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:00:00 20/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 20/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [00:00:00 20/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [00:00:00 20/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 20/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Bloody v2: Thick st: NotStopd t0: [00:00:00 20/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [00:00:00 20/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 305 u1: ml/B st: NotStopd t0: [00:00:00 20/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 20/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 20/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 20/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 20/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 20/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 20/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [00:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 24 u1: BPM st: NotStopd t0: [00:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [01:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [01:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 74.6667 u1: mmHg st: NotStopd t0: [01:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [01:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [01:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [00:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [00:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 80 u1: mmHg st: NotStopd
t0: [00:00:00 20/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 20/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 20/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [02:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [02:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 75.3333 u1: mmHg st: NotStopd t0: [02:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [02:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [23:00:00 20/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 80 cv: 80 ap: none t0: [23:00:00 20/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -35 cv: -35 ap: none t0: [23:00:00 20/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN pv: 5 cv: 120 ap: none t0: [23:00:00 20/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 45 cv: 880 ap: none t0: [23:00:00 20/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 40 cv: 640 ap: none t0: [23:00:00 20/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 80 cv: 1135 ap: none t0: [23:00:00 20/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -35 cv: -255 ap: none t0: [23:00:00 20/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 80 cv: 1135 ap: none t0: [23:00:00 20/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -35 cv: 6071.94 ap: carryForward
t0: [03:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [03:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [03:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78.3333 u1: mmHg st: NotStopd t0: [03:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [03:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [04:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 106 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [04:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78 u1: mmHg st: NotStopd t0: [04:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [04:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [05:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [05:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77.3333 u1: mmHg st: NotStopd t0: [05:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [05:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [06:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [06:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [06:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [06:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 20/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 20/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [00:00:00 20/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [00:00:00 20/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 20/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 20/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 20/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 20/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 20/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 20/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 20/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 20/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 20/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 20/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [00:00:00 20/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 20/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 20/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 20/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 20/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 20/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [00:00:00 20/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 20/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 20/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 20/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 20/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 20/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 20/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 20/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 20/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [00:00:00 20/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 20/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 20/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [00:00:00 20/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 20/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [00:00:00 20/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [01:00:00 20/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [01:00:00 20/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [01:00:00 20/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [01:00:00 20/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [01:00:00 20/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 20/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [01:00:00 20/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [01:00:00 20/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [01:00:00 20/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [01:00:00 20/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [02:00:00 20/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [02:00:00 20/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 20/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [04:00:00 20/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [04:00:00 20/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [04:00:00 20/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [04:00:00 20/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 20/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [04:00:00 20/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 20/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 20/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [04:00:00 20/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 20/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [04:00:00 20/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 20/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 20/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 20/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 20/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 20/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [04:00:00 20/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [04:00:00 20/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 20/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [04:00:00 20/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [04:00:00 20/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [04:00:00 20/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 20/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 20/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 20/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 20/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 20/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [04:00:00 20/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [04:00:00 20/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [04:00:00 20/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [06:00:00 20/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 20/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 20/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 20/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [06:00:00 20/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 20/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 20/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 20/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 20/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [06:00:00 20/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 20/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 20/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 20/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [06:00:00 20/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.0556 u1: Deg. C st: NotStopd t0: [06:00:00 20/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.7 u1: Deg. F st: NotStopd t0: [06:00:00 20/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [06:00:00 20/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 20/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 20/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done
t0: [03:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [04:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [05:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [06:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [06:30:00 20/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 14.8 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: PTT Coags el: 0 cu: MICU cg: 1663 v1: 32.8 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 14.8 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: PTT(22-35) Coags el: 0 cu: MICU cg: 1663 v1: 32.8 rs: Final st: NotStopd
t0: [06:30:00 20/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.3 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 13.3 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 32.5 u1: % rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 10.3 u1: gm/dl rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 498 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.57 u1: /mic l rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.3 rs: Final st: NotStopd
t0: [07:30:00 20/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [07:30:00 20/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [07:30:00 20/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [07:30:00 20/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [07:30:00 20/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [07:30:00 20/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [07:30:00 20/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:30:00 20/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:30:00 20/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [07:30:00 20/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:30:00 20/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:30:00 20/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [07:30:00 20/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 7.9 u1: L/min st: NotStopd t0: [07:30:00 20/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [07:30:00 20/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [07:30:00 20/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [07:30:00 20/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [07:30:00 20/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [07:30:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [07:30:00 20/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 274 u1: ml/B st: NotStopd t0: [07:30:00 20/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [07:30:00 20/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [07:30:00 20/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [07:30:00 20/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [07:30:00 20/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [06:30:00 20/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Albumin Chemistry el: 0 cu: MICU cg: 1663 v1: 3 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 9.5 u1: mg/dl rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 88 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 u1: mEq/L rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 125 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Total Bili Chemistry el: 0 cu: MICU cg: 1663 v1: 0.4 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: ALT Enzymes el: 0 cu: MICU cg: 1663 v1: 7 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: AST Enzymes el: 0 cu: MICU cg: 1663 v1: 16 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Albumin (>3.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 3 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Alk. Phosphate Enzymes el: 0 cu: MICU cg: 1663 v1: 184 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 9.5 u1: mg/dl rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 88 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.7 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.3 u1: mEq/L rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.4 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 125 rs: Final st: NotStopd t0: [06:30:00 20/02/2016] id: Total Bili (0-1.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.4 rs: Final st: NotStopd
t0: [07:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [07:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [07:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [07:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [07:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [07:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [07:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [07:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [07:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [07:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [07:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [07:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 20/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 20/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 20/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [08:00:00 20/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [08:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 20/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [08:00:00 20/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 20/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 20/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 20/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 20/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 20/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 20/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [08:00:00 20/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 20/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 20/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [08:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 20/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [08:00:00 20/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 20/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 20/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 20/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 20/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 20/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 20/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 20/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 20/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 20/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 20/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 20/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 20/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [08:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79.3333 u1: mmHg st: NotStopd t0: [08:00:00 20/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 20/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:00:00 20/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 20/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 20/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 20/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Strong/Palpable v2: Strong/Palpable st: NotStopd t0: [08:00:00 20/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 20/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 20/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 20/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [08:00:00 20/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 20/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 20/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 20/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 20/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [08:00:00 20/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 20/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 20/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 20/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 20/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [07:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [07:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [08:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [08:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [09:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [09:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [09:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [09:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [09:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [09:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 79 u2: mmHg st: NotStopd t0: [09:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91.3333 u1: mmHg st: NotStopd t0: [10:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [10:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [10:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [10:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77.6667 u1: mmHg st: NotStopd t0: [10:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [10:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [10:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [10:00:00 20/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [10:00:00 20/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [10:00:00 20/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [10:00:00 20/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 20/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [10:00:00 20/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [10:00:00 20/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [10:00:00 20/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [10:00:00 20/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [10:00:00 20/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [11:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [11:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [11:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102 u1: mmHg st: NotStopd t0: [11:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [11:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 20/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 20/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 20/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [12:00:00 20/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [12:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 20/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [12:00:00 20/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 20/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 20/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 20/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [12:00:00 20/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 20/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 20/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 20/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 20/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [12:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 20/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 20/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 20/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 20/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 20/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 20/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 20/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 20/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 20/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 20/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 20/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 20/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 20/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 20/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [12:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81 u1: mmHg st: NotStopd t0: [12:00:00 20/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 20/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [12:00:00 20/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 20/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 20/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [12:00:00 20/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 20/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 20/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 20/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 20/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [12:00:00 20/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 20/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 20/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [12:00:00 20/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 20/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [12:00:00 20/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [12:00:00 20/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [12:00:00 20/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [12:00:00 20/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 20/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 20/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [12:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 20/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [12:00:00 20/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [11:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [11:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [12:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml
t0: [12:20:00 20/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:20:00 20/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:20:00 20/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:20:00 20/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [12:20:00 20/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:20:00 20/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:20:00 20/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:20:00 20/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:20:00 20/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:20:00 20/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [12:20:00 20/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 8.8 u1: L/min st: NotStopd t0: [12:20:00 20/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [12:20:00 20/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:20:00 20/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [12:20:00 20/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [12:20:00 20/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:20:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [12:20:00 20/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 295 u1: ml/B st: NotStopd t0: [12:20:00 20/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:20:00 20/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:20:00 20/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:20:00 20/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:20:00 20/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [13:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [13:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [13:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.333 u1: mmHg st: NotStopd t0: [13:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [13:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [13:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml
t0: [14:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [14:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [14:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.3333 u1: mmHg st: NotStopd t0: [14:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 20 u1: BPM st: NotStopd t0: [14:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml st: Stopped t0: [13:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vu: ml t0: [14:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml
t0: [15:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [15:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [15:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [15:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [15:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml
t0: [23:00:00 20/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 120 ap: none
t0: [14:00:00 20/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 20/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 20/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 20/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 20/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [14:00:00 20/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 20/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [14:00:00 20/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [14:00:00 20/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [14:00:00 20/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 20/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 20/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 20/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [16:00:00 20/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [16:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 20/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [16:00:00 20/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [16:00:00 20/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 20/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 20/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 20/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 20/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 20/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 20/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 20/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [16:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 20/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 20/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 20/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 20/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 20/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 20/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 20/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 20/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 20/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 20/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 20/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 20/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 20/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 20/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [16:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [16:00:00 20/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 20/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 20/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 20/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 20/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 20/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 20/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 20/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 20/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 20/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [16:00:00 20/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 20/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 20/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 20/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 20/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.9444 u1: Deg. C st: NotStopd t0: [16:00:00 20/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.5 u1: Deg. F st: NotStopd t0: [16:00:00 20/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 20/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 20/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 20/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 20/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 20/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 20/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [16:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml
t0: [16:20:00 20/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:20:00 20/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:20:00 20/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:20:00 20/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [16:20:00 20/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:20:00 20/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:20:00 20/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:20:00 20/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:20:00 20/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [16:20:00 20/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:20:00 20/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:20:00 20/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [16:20:00 20/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.9 u1: L/min st: NotStopd t0: [16:20:00 20/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [16:20:00 20/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:20:00 20/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [16:20:00 20/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [16:20:00 20/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:20:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [16:20:00 20/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 318 u1: ml/B st: NotStopd t0: [16:20:00 20/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:20:00 20/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:20:00 20/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:20:00 20/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:20:00 20/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [16:22:00 20/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd t0: [16:22:00 20/02/2016] id: Uric Acid Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd t0: [16:22:00 20/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd t0: [16:22:00 20/02/2016] id: Uric Acid (2.7-7.0) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd
t0: [17:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [17:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 147 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [17:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.6667 u1: mmHg st: NotStopd t0: [17:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 40 u1: BPM st: NotStopd t0: [17:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml
t0: [17:00:00 20/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [17:00:00 20/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd t0: [18:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 20/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [18:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 20/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 20/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [18:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100.667 u1: mmHg st: NotStopd t0: [18:00:00 20/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 20/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [18:00:00 20/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [18:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [18:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 20/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [18:00:00 20/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [18:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml
t0: [16:22:00 20/02/2016] id: Serum Osmolality Chemistry el: 0 cu: MICU cg: 1663 v1: 278 rs: Final st: NotStopd
t0: [20:00:00 20/02/2016] id: I:E Ratio el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 20/02/2016] id: Peak Flow el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 20/02/2016] id: Resp Rate (Spont) el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 20/02/2016] id: Respiratory Rate Set el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 20/02/2016] id: Tidal Volume (Set) el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 20/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: -1 st: D/C'd
t0: [19:00:00 20/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [19:00:00 20/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [19:00:00 20/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [19:00:00 20/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [19:00:00 20/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [19:00:00 20/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [19:00:00 20/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [19:00:00 20/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [19:00:00 20/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [19:00:00 20/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [19:00:00 20/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [19:00:00 20/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [19:00:00 20/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.2 u1: L/min st: NotStopd t0: [19:00:00 20/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [19:00:00 20/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [19:00:00 20/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [19:00:00 20/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [19:00:00 20/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [19:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [19:00:00 20/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Tan v2: Thick st: NotStopd t0: [19:00:00 20/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [19:00:00 20/02/2016] id: Tidal Volume (Spont) el: 0 cu: MICU cg: RRT v1: 359 u1: ml/B st: NotStopd t0: [19:00:00 20/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [19:00:00 20/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [19:00:00 20/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [19:00:00 20/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [19:00:00 20/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [19:00:00 20/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [19:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [19:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [19:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [19:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [19:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 20/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 20/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 20/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [20:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 20/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [20:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 20/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 20/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 20/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 20/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 20/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 20/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 20/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 20/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [20:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 20/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [20:00:00 20/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 20/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 20/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 20/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 20/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 20/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 20/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 20/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 20/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 20/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 20/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 20/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 149 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [20:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98.3333 u1: mmHg st: NotStopd t0: [20:00:00 20/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 20/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 20/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 20/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 20/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 20/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 20/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 20/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 20/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 56 u1: BPM st: NotStopd t0: [20:00:00 20/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 20/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 20/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 20/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 20/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 20/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [20:00:00 20/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [20:00:00 20/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 20/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [20:00:00 20/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 20/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 20/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 20/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 20/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 20/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [20:00:00 20/02/2016] tf: [10:00:00 21/02/2016] dt: 840 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml nb: 1
t0: [20:00:00 20/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 20/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [20:00:00 20/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [21:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [21:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [21:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [21:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [21:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [21:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [22:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [22:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [22:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 108 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [22:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 71.3333 u1: mmHg st: NotStopd t0: [22:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [22:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [22:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [23:00:00 20/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 20/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 20/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 20/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 20/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 20/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [23:00:00 20/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [23:00:00 20/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [23:00:00 20/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [23:00:00 20/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 20/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [23:00:00 20/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 20/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 20/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [23:00:00 20/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [00:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [00:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [00:00:00 21/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 21/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [00:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 82.3333 u1: mmHg st: NotStopd t0: [00:00:00 21/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 21/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 21/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 39 u1: BPM st: NotStopd t0: [00:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 21/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 21/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [00:00:00 21/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [00:00:00 21/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 21/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 21/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [00:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [00:00:00 21/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 21/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [00:00:00 21/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [00:00:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 21/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 21/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [00:00:00 21/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 21/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 21/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 21/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.48 u1: L/min st: NotStopd t0: [00:00:00 21/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:00:00 21/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 21/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 28 u1: . st: NotStopd t0: [00:00:00 21/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 28 u1: BPM st: NotStopd t0: [00:00:00 21/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [00:00:00 21/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 353 u1: ml/B st: NotStopd t0: [00:00:00 21/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 21/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 21/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [01:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [01:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [01:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 109 u1: mmHg v2: 55 u2: mmHg st: NotStopd t0: [01:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [01:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [01:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 21/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [01:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [02:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [02:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [02:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.3333 u1: mmHg st: NotStopd t0: [02:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [02:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 21/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [02:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [23:00:00 21/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 21/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 1325 ap: none t0: [23:00:00 21/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 1325 ap: none
t0: [03:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [03:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [03:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [03:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 45 u2: mmHg st: NotStopd t0: [03:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [03:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [03:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 21/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [03:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [23:00:00 21/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 40 cv: 40 ap: none t0: [23:00:00 21/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 395 ap: none t0: [23:00:00 21/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 40 cv: 1535 ap: none t0: [23:00:00 21/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 40 cv: 520 ap: none t0: [23:00:00 21/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 40 cv: 210 ap: none t0: [23:00:00 21/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 40 cv: 6281.94 ap: carryForward
t0: [04:30:00 21/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:30:00 21/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:30:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:30:00 21/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [04:30:00 21/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [04:30:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:30:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:30:00 21/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 34.9 u1: Deg. C st: NotStopd t0: [04:30:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:30:00 21/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [04:30:00 21/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [04:30:00 21/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.5 u1: L/min st: NotStopd t0: [04:30:00 21/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:30:00 21/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:30:00 21/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 28 u1: . st: NotStopd t0: [04:30:00 21/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 30 u1: BPM st: NotStopd t0: [04:30:00 21/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [04:30:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [04:30:00 21/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 351 u1: ml/B st: NotStopd t0: [04:30:00 21/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:30:00 21/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:30:00 21/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:30:00 21/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:30:00 21/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:30:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 20/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [21:00:00 20/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [21:00:00 20/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 20/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [21:00:00 20/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [21:00:00 20/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [00:00:00 21/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 21/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [00:00:00 21/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [00:00:00 21/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 21/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 21/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 21/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 21/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 21/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 21/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 21/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 21/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 21/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 21/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 21/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 21/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 21/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 21/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 21/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 21/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 21/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 21/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 21/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 21/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [00:00:00 21/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 21/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 21/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [00:00:00 21/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 21/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 17 u1: number st: NotStopd t0: [00:00:00 21/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [02:00:00 21/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [02:00:00 21/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [02:00:00 21/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 21/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [02:00:00 21/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [02:00:00 21/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [03:00:00 21/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [03:00:00 21/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [04:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 21/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 21/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 21/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 21/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 21/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 94 u1: mmHg v2: 41 u2: mmHg st: NotStopd t0: [04:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 58.6667 u1: mmHg st: NotStopd t0: [04:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 53 u1: BPM st: NotStopd t0: [04:00:00 21/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 21/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 21/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 21/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [05:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [05:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [05:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [05:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 67.6667 u1: mmHg st: NotStopd t0: [05:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [05:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [05:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 21/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [04:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [05:00:00 21/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [05:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [06:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [06:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [06:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg v2: 51 u2: mmHg st: NotStopd t0: [06:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 65.6667 u1: mmHg st: NotStopd t0: [06:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [06:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 21/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 5 vu: ml t0: [06:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [04:00:00 21/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [04:00:00 21/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [04:00:00 21/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [06:00:00 21/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 21/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [06:00:00 21/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [06:00:00 21/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [06:00:00 21/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [06:00:00 21/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [06:00:00 21/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [06:00:00 21/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [06:00:00 21/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [06:00:00 21/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [06:00:00 21/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [06:00:00 21/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [06:00:00 21/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [06:00:00 21/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [06:00:00 21/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [06:00:00 21/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [06:00:00 21/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [06:00:00 21/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 21/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [06:00:00 21/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [06:00:00 21/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [06:00:00 21/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [06:00:00 21/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [06:00:00 21/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [06:00:00 21/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 21/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [06:00:00 21/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [06:00:00 21/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 21/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [06:00:00 21/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 21/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 21/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Formed st: NotStopd t0: [06:00:00 21/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [06:00:00 21/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [06:00:00 21/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [06:00:00 21/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Amber v2: Clear st: NotStopd t0: [06:00:00 21/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [06:00:00 21/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [06:00:00 21/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [06:00:00 21/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [06:30:00 21/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 12.7 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 12.7 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 29.2 u1: % rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.4 u1: gm/dl rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 438 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.27 u1: /mic l rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 12.7 rs: Final st: NotStopd
t0: [06:30:00 21/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 25 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.8 u1: mEq/L rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 25 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 33 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 92 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.8 u1: mEq/L rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.2 rs: Final st: NotStopd t0: [06:30:00 21/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd
t0: [09:00:00 21/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [09:00:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [09:00:00 21/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [09:00:00 21/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [09:00:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [09:00:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [09:00:00 21/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [09:00:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [09:00:00 21/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [09:00:00 21/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [09:00:00 21/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [09:00:00 21/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [09:00:00 21/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.21 u1: L/min st: NotStopd t0: [09:00:00 21/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [09:00:00 21/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 28 u1: . st: NotStopd t0: [09:00:00 21/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [09:00:00 21/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [09:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [09:00:00 21/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thin st: NotStopd t0: [09:00:00 21/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [09:00:00 21/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 308 u1: ml/B st: NotStopd t0: [09:00:00 21/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [09:00:00 21/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [09:00:00 21/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [09:00:00 21/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [09:00:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [10:00:00 21/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: -1 ai: 107 vo: 0 st: D/C'd
t0: [08:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 21/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 21/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 21/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [08:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [08:00:00 21/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 21/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 21/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [08:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [08:00:00 21/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [08:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [08:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [08:00:00 21/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 21/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [08:00:00 21/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [08:00:00 21/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [09:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [09:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [09:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [09:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [09:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 179 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [09:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 115 u1: mmHg st: NotStopd t0: [09:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [09:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [09:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [10:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.3 u1: torr st: NotStopd t0: [10:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [10:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [10:00:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [10:00:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [10:00:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [10:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 78 u2: mmHg st: NotStopd t0: [10:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [10:00:00 21/02/2016] id: PEEP Set el: 0 cu: MICU cg: RN v1: 5 u1: cmH2O st: NotStopd t0: [10:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 21/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [10:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [10:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 21/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [10:00:00 21/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [10:00:00 21/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RN v1: 310 u1: ml/B st: NotStopd t0: [10:00:00 21/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RN v1: CPAP+PS st: NotStopd t0: [10:00:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [10:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [11:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [11:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [11:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 70.6667 u1: mmHg st: NotStopd t0: [11:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [11:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 21/02/2016] id: .9% Normal Saline 250.0ml IV Infusions el: 1 cu: MICU cg: RN ai: 107 vo: 10 vu: ml t0: [08:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 80 vu: ml t0: [10:00:00 21/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 120 vu: ml t0: [10:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml
t0: [23:00:00 21/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: none
t0: [08:00:00 21/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [08:00:00 21/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [08:00:00 21/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 21/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 21/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 21/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Other/Remarks st: NotStopd t0: [08:00:00 21/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 21/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 21/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 21/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 21/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 21/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 21/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 21/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [08:00:00 21/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 21/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 21/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 21/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 21/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 21/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 21/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 21/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [08:00:00 21/02/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 21/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 21/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 21/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 21/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [08:00:00 21/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 21/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 21/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 21/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 21/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 21/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 21/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Not Applicable st: NotStopd t0: [08:00:00 21/02/2016] id: Stool Management el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 21/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 21/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 21/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 21/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 21/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 21/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done t0: [08:00:00 21/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 21/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [12:00:00 21/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 21/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 23 st: NotStopd t0: [12:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Agitated st: NotStopd t0: [12:00:00 21/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [12:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 21/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [12:00:00 21/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 21/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 21/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [12:00:00 21/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 21/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Other/Remarks st: NotStopd t0: [12:00:00 21/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 21/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 21/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [12:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 21/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [12:00:00 21/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 21/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 21/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 21/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 21/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 21/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [12:00:00 21/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 21/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [12:00:00 21/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [12:00:00 21/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [12:00:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [12:00:00 21/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [12:00:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [12:00:00 21/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 21/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 21/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 21/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 132 u1: mmHg v2: 63 u2: mmHg st: NotStopd t0: [12:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86 u1: mmHg st: NotStopd t0: [12:00:00 21/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 21/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [12:00:00 21/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 21/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 21/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [12:00:00 21/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 21/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [12:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 21/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [12:00:00 21/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 21/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [12:00:00 21/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 21/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [12:00:00 21/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 80 u1: % st: NotStopd t0: [12:00:00 21/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 21/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [12:00:00 21/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [12:00:00 21/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [12:00:00 21/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [12:00:00 21/02/2016] id: Trach Size el: 0 cu: MICU cg: RN v1: #8 st: NotStopd t0: [12:00:00 21/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Portex st: NotStopd t0: [12:00:00 21/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [12:00:00 21/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [12:00:00 21/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [12:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 21/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [12:00:00 21/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [12:00:00 21/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [12:00:00 21/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [12:00:00 21/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [12:00:00 21/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [12:00:00 21/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [12:00:00 21/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 17 u1: number st: NotStopd t0: [12:00:00 21/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd
t0: [12:00:00 21/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 60 vu: ml t0: [12:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml
t0: [13:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [13:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [13:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [13:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [13:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [13:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:45:00 21/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [12:45:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [12:45:00 21/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [12:45:00 21/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [12:45:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [12:45:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [12:45:00 21/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [12:45:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [12:45:00 21/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 5 st: NotStopd t0: [12:45:00 21/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [12:45:00 21/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.3 u1: L/min st: NotStopd t0: [12:45:00 21/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [12:45:00 21/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 28 u1: . st: NotStopd t0: [12:45:00 21/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [12:45:00 21/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [12:45:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [12:45:00 21/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 346 u1: ml/B st: NotStopd t0: [12:45:00 21/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [12:45:00 21/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [12:45:00 21/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [12:45:00 21/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [12:45:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [09:00:00 21/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd
t0: [12:45:00 21/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd
t0: [13:15:00 21/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.4 u1: L/min st: NotStopd t0: [13:15:00 21/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [13:15:00 21/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [13:15:00 21/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 357 u1: ml/B st: NotStopd
tf: [13:00:00 22/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 14 dn: 1 m1: Magnesium Sulfate v1: 2 u1: gm
t0: [14:00:00 21/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [14:00:00 21/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 23 st: NotStopd t0: [14:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.3 u1: torr st: NotStopd t0: [14:00:00 21/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [14:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 21/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 21/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [14:00:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [14:00:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [14:00:00 21/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [14:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 135 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [14:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.3333 u1: mmHg st: NotStopd t0: [14:00:00 21/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [14:00:00 21/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [14:00:00 21/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [14:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [14:00:00 21/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 21/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [14:00:00 21/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [14:00:00 21/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [14:00:00 21/02/2016] id: Trach Size el: 0 cu: MICU cg: RN v1: #8 st: NotStopd t0: [14:00:00 21/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Portex st: NotStopd t0: [14:00:00 21/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [14:00:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [14:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 21/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd
t0: [14:00:00 21/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 60 vu: ml
t0: [15:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [15:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [15:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [15:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [15:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [15:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [15:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [15:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [15:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [15:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [15:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [15:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [15:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 21/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [16:00:00 21/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 23 st: NotStopd t0: [16:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 21/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [16:00:00 21/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 21/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 21/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 21/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding v2: Other/Remarks st: NotStopd t0: [16:00:00 21/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 21/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 21/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [16:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 21/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 21/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 21/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 21/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 21/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 21/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 21/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 21/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [16:00:00 21/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [16:00:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [16:00:00 21/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [16:00:00 21/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 21/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 21/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 21/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [16:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 84.3333 u1: mmHg st: NotStopd t0: [16:00:00 21/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 21/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 21/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [16:00:00 21/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [16:00:00 21/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [16:00:00 21/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Weak Palpable v2: Weak Palpable st: NotStopd t0: [16:00:00 21/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [16:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 21/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Absent st: NotStopd t0: [16:00:00 21/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 21/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [16:00:00 21/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 21/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 21/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 94 u1: % st: NotStopd t0: [16:00:00 21/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 21/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 21/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [16:00:00 21/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd t0: [16:00:00 21/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 21/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [16:00:00 21/02/2016] id: Trach Size el: 0 cu: MICU cg: RN v1: #8 st: NotStopd t0: [16:00:00 21/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Portex st: NotStopd t0: [16:00:00 21/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [16:00:00 21/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [16:00:00 21/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 21/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 21/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [16:00:00 21/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 60 vu: ml
t0: [16:20:00 21/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:20:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:20:00 21/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [16:20:00 21/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [16:20:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:20:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:20:00 21/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:20:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:20:00 21/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [16:20:00 21/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:20:00 21/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:20:00 21/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 11 u1: cmH2O st: NotStopd t0: [16:20:00 21/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.2 u1: L/min st: NotStopd t0: [16:20:00 21/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [16:20:00 21/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:20:00 21/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [16:20:00 21/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [16:20:00 21/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [16:20:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [16:20:00 21/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [16:20:00 21/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [16:20:00 21/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 352 u1: ml/B st: NotStopd t0: [16:20:00 21/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:20:00 21/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:20:00 21/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:20:00 21/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:20:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [12:45:00 21/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [12:45:00 21/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd
t0: [16:43:00 21/02/2016] id: Venous CO2(Calc) VBG'S el: 0 cu: MICU cg: 1663 v1: 36 rs: Final st: NotStopd t0: [16:43:00 21/02/2016] id: Venous PvCO2 VBG's el: 0 cu: MICU cg: 1663 v1: 52 u1: mmHg rs: Final st: NotStopd t0: [16:43:00 21/02/2016] id: Venous PvO2 Mixed Venous Gases el: 0 cu: MICU cg: 1663 v1: 36 u1: mmHg rs: Final st: NotStopd t0: [16:43:00 21/02/2016] id: Venous pH VBG's el: 0 cu: MICU cg: 1663 v1: 7.43 u1: pH rs: Final st: NotStopd
t0: [17:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [17:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [17:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [17:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [17:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [17:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [17:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [17:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [17:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92 u1: mmHg st: NotStopd t0: [17:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [17:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [17:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [17:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:48:00 21/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 16.3 rs: Final st: NotStopd t0: [16:48:00 21/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [16:48:00 21/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [16:48:00 21/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 16.3 rs: Final st: NotStopd
t0: [18:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [18:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 138 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [18:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.3333 u1: mmHg st: NotStopd t0: [18:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [18:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 21/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 21/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 21/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [18:00:00 21/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [18:00:00 21/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 23 st: NotStopd t0: [18:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RN v1: 0.3 u1: torr st: NotStopd t0: [18:00:00 21/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [18:00:00 21/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [18:00:00 21/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [18:00:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [18:00:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [18:00:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [18:00:00 21/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [18:00:00 21/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [18:00:00 21/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [18:00:00 21/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [18:00:00 21/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 21/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [18:00:00 21/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [18:00:00 21/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RN v1: 358 u1: ml/B st: NotStopd t0: [18:00:00 21/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [18:00:00 21/02/2016] id: Trach Size el: 0 cu: MICU cg: RN v1: #8 st: NotStopd t0: [18:00:00 21/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Portex st: NotStopd t0: [18:00:00 21/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [18:00:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [18:00:00 21/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [19:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [19:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [19:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [19:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [19:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [19:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [19:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [19:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [19:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.3333 u1: mmHg st: NotStopd t0: [19:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [19:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [19:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [19:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 21/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 60 vu: ml
t0: [20:00:00 21/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 21/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 21/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [20:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 21/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 21/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 21/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 21/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [20:00:00 21/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 21/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 21/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [20:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 21/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 21/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 21/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 21/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 21/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 21/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 21/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 21/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 139 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [20:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94.3333 u1: mmHg st: NotStopd t0: [20:00:00 21/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 21/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 21/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 21/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 21/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 21/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [20:00:00 21/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 21/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 21/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 21/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 21/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 21/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 21/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 21/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 21/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 21/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 200 vu: ml t0: [20:00:00 21/02/2016] tf: [17:24:00 26/02/2016] dt: 7044 id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [23:00:00 21/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 620 ap: none
t0: [20:05:00 21/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:05:00 21/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:05:00 21/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 40 u1: cmH2O st: NotStopd t0: [20:05:00 21/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [20:05:00 21/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:05:00 21/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:05:00 21/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:05:00 21/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:05:00 21/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [20:05:00 21/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:05:00 21/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:05:00 21/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 10 u1: cmH2O st: NotStopd t0: [20:05:00 21/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.34 u1: L/min st: NotStopd t0: [20:05:00 21/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [20:05:00 21/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:05:00 21/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [20:05:00 21/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [20:05:00 21/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 3 u1: cmH2O st: NotStopd t0: [20:05:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:05:00 21/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:05:00 21/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:05:00 21/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 330 u1: ml/B st: NotStopd t0: [20:05:00 21/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:05:00 21/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:05:00 21/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:05:00 21/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:05:00 21/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 21/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 21/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 21/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 21/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 21/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 21/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 21/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [20:00:00 21/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 21/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: Independent st: NotStopd t0: [20:00:00 21/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 21/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [20:00:00 21/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [20:00:00 21/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [20:00:00 21/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd
tf: [21:00:00 26/02/2016] pt: Unit Dose rt: PO fr: BID fs: 10, 22 dn: 2 m1: Metoprolol v1: 25 u1: mg
t0: [21:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [21:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 100 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [21:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 68.6667 u1: mmHg st: NotStopd t0: [21:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [21:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 89 u1: % st: NotStopd t0: [21:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [22:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 46 u2: mmHg st: NotStopd t0: [22:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 65 u1: mmHg st: NotStopd t0: [22:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 41 u1: BPM st: NotStopd t0: [22:00:00 21/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [22:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:00:00 21/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 21/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 21/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 21/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 21/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 21/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [23:00:00 21/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 21/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg v2: 49 u2: mmHg st: NotStopd t0: [23:00:00 21/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 64.3333 u1: mmHg st: NotStopd t0: [23:00:00 21/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 21/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 42 u1: BPM st: NotStopd t0: [23:00:00 21/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [21:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [22:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [23:00:00 21/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [23:00:00 21/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [23:00:00 21/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 28 u1: . st: NotStopd
t0: [00:00:00 22/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 22/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 22/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 22/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 22/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [00:00:00 22/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 22/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 22/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.2 u1: Deg. C st: NotStopd t0: [00:00:00 22/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 22/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [00:00:00 22/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 22/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 22/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 22/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.6 u1: L/min st: NotStopd t0: [00:00:00 22/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:00:00 22/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 22/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 28 u1: . st: NotStopd t0: [00:00:00 22/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [00:00:00 22/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [00:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [00:00:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 22/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 321 u1: ml/B st: NotStopd t0: [00:00:00 22/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 22/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 22/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 22/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 22/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 22/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [00:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [00:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.3333 u1: mmHg st: NotStopd t0: [00:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 45 u1: BPM st: NotStopd t0: [00:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [01:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 127 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [01:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.6667 u1: mmHg st: NotStopd t0: [01:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [01:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [01:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 22/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [01:00:00 22/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [00:00:00 22/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [02:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 101 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [02:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 69 u1: mmHg st: NotStopd t0: [02:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [02:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [03:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [03:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 47 u2: mmHg st: NotStopd t0: [03:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 74.3333 u1: mmHg st: NotStopd t0: [03:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [03:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [03:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 22/02/2016] id: Criticare HN Tube Feeding el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [03:00:00 22/02/2016] tf: [08:00:00 22/02/2016] dt: 300 id: Tube Feeding PO/Gastric el: 2 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [23:00:00 22/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 22/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: 40 cv: 40 ap: none t0: [23:00:00 22/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 40 cv: 1970 ap: none t0: [23:00:00 22/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN pv: 40 cv: 400 ap: none t0: [23:00:00 22/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 1220 ap: none t0: [23:00:00 22/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: 40 cv: 750 ap: none t0: [23:00:00 22/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 1220 ap: none t0: [23:00:00 22/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: 40 cv: 7031.94 ap: carryForward
t0: [04:00:00 22/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 22/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 22/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 22/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 22/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [04:00:00 22/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 22/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 22/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 22/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 22/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 7 st: NotStopd t0: [04:00:00 22/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 22/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 22/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [04:00:00 22/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.3 u1: L/min st: NotStopd t0: [04:00:00 22/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:00:00 22/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 22/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 28 u1: . st: NotStopd t0: [04:00:00 22/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [04:00:00 22/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [04:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [04:00:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: White v2: Thick st: NotStopd t0: [04:00:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [04:00:00 22/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 340 u1: ml/B st: NotStopd t0: [04:00:00 22/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 22/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 22/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 22/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 22/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:00:00 22/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 22/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 22/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 22/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 22/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 22/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [03:00:00 22/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [03:00:00 22/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [03:00:00 22/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [04:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 22/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 22/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [04:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90.6667 u1: mmHg st: NotStopd t0: [04:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [04:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [05:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 116 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [05:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 74 u1: mmHg st: NotStopd t0: [05:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [05:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [05:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:00:00 22/02/2016] id: Tube Feeding PO/Gastric el: 2 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [05:00:00 22/02/2016] id: Tube Feeding PO/Gastric el: 2 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [00:00:00 22/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [00:00:00 22/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 22/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 22/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 22/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [00:00:00 22/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 22/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 22/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 22/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 22/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 22/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 22/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [00:00:00 22/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 22/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [00:00:00 22/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 22/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 22/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 22/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 22/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 22/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 22/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 22/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 22/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 22/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 22/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [00:00:00 22/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 22/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 22/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Occ. Moist st: NotStopd t0: [00:00:00 22/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 22/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 15 u1: number st: NotStopd t0: [00:00:00 22/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [04:00:00 22/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [04:00:00 22/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [04:00:00 22/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [04:00:00 22/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [04:00:00 22/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [04:00:00 22/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 22/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [04:00:00 22/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 22/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [04:00:00 22/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 22/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 22/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 22/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 22/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 22/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [06:00:00 22/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [06:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 22/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [06:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 52 u2: mmHg st: NotStopd t0: [06:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 69.6667 u1: mmHg st: NotStopd t0: [06:00:00 22/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [06:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [06:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 22/02/2016] id: Tube Feeding PO/Gastric el: 2 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
id: Tube Feeding el: 2 cu: MICU cg: RN io: Tube Feeding PO/Gastric du: ml rt: Gastric/Feeding Tube
t0: [00:00:00 22/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 22/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.8889 u1: Deg. C st: NotStopd t0: [00:00:00 22/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.4 u1: Deg. F st: NotStopd
t0: [06:00:00 22/02/2016] tf: [11:00:00 22/02/2016] dt: 300 id: fluid bolus Free Form Intake el: 1 cu: MICU cg: RN vo: 500 vu: ml
t0: [03:00:00 22/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [03:00:00 22/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [03:00:00 22/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [06:00:00 22/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [06:00:00 22/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [06:00:00 22/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98 u1: Deg. F st: NotStopd
t0: [06:37:00 22/02/2016] id: PT el: 0 cu: MICU cg: 1663 v1: 15.3 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: INR Coags el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: INR (2-4 ref. range) Coags el: 0 cu: MICU cg: 1663 v1: 1.5 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: PT(11-13.5) Coags el: 0 cu: MICU cg: 1663 v1: 15.3 rs: Final st: NotStopd
t0: [06:37:00 22/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 93 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 127 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 93 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 101 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.2 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.9 u1: mEq/L rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.1 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 127 rs: Final st: NotStopd
t0: [08:00:00 22/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: rrt v1: 1 v2: 23 st: NotStopd t0: [08:00:00 22/02/2016] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 22/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 7 u1: cmH2O st: NotStopd t0: [08:00:00 22/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 45 u1: BPM st: NotStopd t0: [08:00:00 22/02/2016] id: Airway Size el: 0 cu: MICU cg: rrt v1: 8.0 mm st: NotStopd t0: [08:00:00 22/02/2016] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [08:00:00 22/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 34.9 u1: Deg. C st: NotStopd t0: [08:00:00 22/02/2016] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 12 v2: 23 st: NotStopd t0: [08:00:00 22/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 45 st: NotStopd t0: [08:00:00 22/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 22/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 22/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: rrt v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 22/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 11.4 u1: L/min st: NotStopd t0: [08:00:00 22/02/2016] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 8 u1: cmH2O st: NotStopd t0: [08:00:00 22/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [08:00:00 22/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 28 u1: . st: NotStopd t0: [08:00:00 22/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 31 u1: BPM st: NotStopd t0: [08:00:00 22/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 4 u1: cmH2O st: NotStopd t0: [08:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: rrt v1: 100 u1: % st: NotStopd t0: [08:00:00 22/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: rrt v1: 415 u1: ml/B st: NotStopd t0: [08:00:00 22/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: rrt v1: Yes v2: No st: NotStopd t0: [08:00:00 22/02/2016] id: Trach Size el: 0 cu: MICU cg: rrt v1: #8 st: NotStopd t0: [08:00:00 22/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: rrt v1: Portex st: NotStopd t0: [08:00:00 22/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [08:00:00 22/02/2016] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
t0: [06:37:00 22/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 23 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 23 rs: Final st: NotStopd
t0: [06:37:00 22/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.9 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 13.9 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 28.6 u1: % rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.3 u1: gm/dl rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 381 rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.19 u1: /mic l rs: Final st: NotStopd t0: [06:37:00 22/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.9 rs: Final st: NotStopd
t0: [08:00:00 22/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [08:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 22/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 22/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [08:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 22/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 22/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 22/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 22/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 22/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 22/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 22/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 22/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [08:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 22/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 22/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 22/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 22/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 22/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [08:00:00 22/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 22/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Normal Saline st: NotStopd t0: [08:00:00 22/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 22/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 22/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [08:00:00 22/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 22/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 22/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 22/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 22/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 22/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 131 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [08:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.3333 u1: mmHg st: NotStopd t0: [08:00:00 22/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 22/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 22/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [08:00:00 22/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 22/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [08:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 22/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 22/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 22/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 28 u1: BPM st: NotStopd t0: [08:00:00 22/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [08:00:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [08:00:00 22/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 22/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [08:00:00 22/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [08:00:00 22/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 22/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [08:00:00 22/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 22/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 22/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 22/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [08:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 22/02/2016] id: Bath el: 1 cu: MICU cg: RN v1: done t0: [08:00:00 22/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [08:00:00 22/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 22/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [08:00:00 22/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 22/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [08:00:00 22/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 22/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Very Poor st: NotStopd t0: [08:00:00 22/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 13 u1: number st: NotStopd t0: [08:00:00 22/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:00:00 22/02/2016] id: Tube Feeding PO/Gastric el: 2 cu: MICU cg: RN ai: 498 vo: 80 vu: ml st: Stopped
t0: [09:00:00 22/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 23 st: NotStopd t0: [09:00:00 22/02/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [09:00:00 22/02/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [09:00:00 22/02/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [09:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [09:00:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [09:00:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [09:00:00 22/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [09:00:00 22/02/2016] id: Trach Size el: 0 cu: MICU cg: RN v1: #8 st: NotStopd t0: [09:00:00 22/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Portex st: NotStopd t0: [09:00:00 22/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [10:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 22/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 22/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [10:00:00 22/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [10:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 22/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Chair st: NotStopd t0: [10:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 117.333 u1: mmHg st: NotStopd t0: [10:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 48 u1: BPM st: NotStopd t0: [10:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 22/02/2016] id: fluid bolus Free Form Intake el: 1 cu: MICU cg: RN vu: ml t0: [10:00:00 22/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 120 vu: ml
t0: [11:00:00 22/02/2016] id: fluid bolus Free Form Intake el: 1 cu: MICU cg: -1 vo: 0 st: D/C'd
tf: [21:00:00 26/02/2016] pt: Unit Dose rt: SC fr: Q12H fs: 11, 23 dn: 2 m1: Enoxaparin Sodium v1: 30 u1: mg
t0: [11:00:00 22/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: rrt v1: 1 v2: 23 st: NotStopd t0: [11:00:00 22/02/2016] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.3 u1: torr st: NotStopd t0: [11:00:00 22/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 7 u1: cmH2O st: NotStopd t0: [11:00:00 22/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 45 u1: BPM st: NotStopd t0: [11:00:00 22/02/2016] id: Airway Size el: 0 cu: MICU cg: rrt v1: 8.0 mm st: NotStopd t0: [11:00:00 22/02/2016] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [11:00:00 22/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 22/02/2016] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 12 v2: 23 st: NotStopd t0: [11:00:00 22/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 45 st: NotStopd t0: [11:00:00 22/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Albuterol st: NotStopd t0: [11:00:00 22/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Atrovent st: NotStopd t0: [11:00:00 22/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: rrt v1: 14 u1: cmH2O st: NotStopd t0: [11:00:00 22/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 13.1 u1: L/min st: NotStopd t0: [11:00:00 22/02/2016] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 8 u1: cmH2O st: NotStopd t0: [11:00:00 22/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [11:00:00 22/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 28 u1: . st: NotStopd t0: [11:00:00 22/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 35 u1: BPM st: NotStopd t0: [11:00:00 22/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 4 u1: cmH2O st: NotStopd t0: [11:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: rrt v1: 100 u1: % st: NotStopd t0: [11:00:00 22/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: rrt v1: 377 u1: ml/B st: NotStopd t0: [11:00:00 22/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: rrt v1: Yes v2: No st: NotStopd t0: [11:00:00 22/02/2016] id: Trach Size el: 0 cu: MICU cg: rrt v1: #8 st: NotStopd t0: [11:00:00 22/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: rrt v1: Portex st: NotStopd t0: [11:00:00 22/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [11:00:00 22/02/2016] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
t0: [10:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 95 u2: mmHg st: NotStopd t0: [10:00:00 22/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [11:00:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [12:00:00 22/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [12:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 22/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 22/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 22/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [12:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [12:00:00 22/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 22/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 22/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [12:00:00 22/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [12:00:00 22/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 22/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [12:00:00 22/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 22/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 22/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [12:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [12:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 22/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 22/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 22/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [12:00:00 22/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [12:00:00 22/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [12:00:00 22/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [12:00:00 22/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [12:00:00 22/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 22/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 22/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 22/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [12:00:00 22/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [12:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.3333 u1: mmHg st: NotStopd t0: [12:00:00 22/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 22/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [12:00:00 22/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [12:00:00 22/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [12:00:00 22/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [12:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 22/02/2016] id: Procedures el: 0 cu: MICU cg: RN v1: Sputum Cx st: NotStopd t0: [12:00:00 22/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [12:00:00 22/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [12:00:00 22/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [12:00:00 22/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [12:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 22/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 22/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [12:00:00 22/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [12:00:00 22/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 22/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 22/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [12:00:00 22/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [12:00:00 22/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [08:00:00 22/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [10:00:00 22/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [12:00:00 22/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [13:00:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [13:00:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [14:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 22/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [14:00:00 22/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 22/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [14:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 22/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 22/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Good st: NotStopd t0: [14:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 111 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [14:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 73 u1: mmHg st: NotStopd t0: [14:00:00 22/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [14:00:00 22/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [14:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [14:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [14:00:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [14:00:00 22/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 22/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 240 vu: ml
t0: [15:00:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [15:00:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd
t0: [16:00:00 22/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: rrt v1: 1 v2: 23 st: NotStopd t0: [16:00:00 22/02/2016] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 22/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 7 u1: cmH2O st: NotStopd t0: [16:00:00 22/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 45 u1: BPM st: NotStopd t0: [16:00:00 22/02/2016] id: Airway Size el: 0 cu: MICU cg: rrt v1: 8.0 mm st: NotStopd t0: [16:00:00 22/02/2016] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [16:00:00 22/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 22/02/2016] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 12 v2: 23 st: NotStopd t0: [16:00:00 22/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 45 st: NotStopd t0: [16:00:00 22/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 22/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 22/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: rrt v1: 15 u1: cmH2O st: NotStopd t0: [16:00:00 22/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 12.5 u1: L/min st: NotStopd t0: [16:00:00 22/02/2016] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 8 u1: cmH2O st: NotStopd t0: [16:00:00 22/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [16:00:00 22/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 28 u1: . st: NotStopd t0: [16:00:00 22/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 33 u1: BPM st: NotStopd t0: [16:00:00 22/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 4 u1: cmH2O st: NotStopd t0: [16:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: rrt v1: 100 u1: % st: NotStopd t0: [16:00:00 22/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: rrt v1: 391 u1: ml/B st: NotStopd t0: [16:00:00 22/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: rrt v1: Yes v2: No st: NotStopd t0: [16:00:00 22/02/2016] id: Trach Size el: 0 cu: MICU cg: rrt v1: #8 st: NotStopd t0: [16:00:00 22/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: rrt v1: Portex st: NotStopd t0: [16:00:00 22/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [16:00:00 22/02/2016] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
t0: [16:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 22/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 22/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 22/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [16:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 22/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 22/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 22/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 22/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 22/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 22/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 22/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [16:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 22/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 22/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 22/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 22/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 22/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 22/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 22/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 22/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 22/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 22/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 22/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 22/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 22/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 119 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [16:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.6667 u1: mmHg st: NotStopd t0: [16:00:00 22/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 22/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 22/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [16:00:00 22/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: Off st: NotStopd t0: [16:00:00 22/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 22/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 22/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 22/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 22/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [16:00:00 22/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 22/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 22/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 22/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 22/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [16:00:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [16:00:00 22/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 22/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 22/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.5556 u1: Deg. C st: NotStopd t0: [16:00:00 22/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 99.6 u1: Deg. F st: NotStopd t0: [16:00:00 22/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 22/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 22/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 22/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 22/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 22/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 22/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 22/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [17:00:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [17:00:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Small st: NotStopd t0: [18:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [18:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 86.6667 u1: mmHg st: NotStopd t0: [18:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [18:00:00 22/02/2016] id: Significant Events el: 0 cu: MICU cg: RN st: NotStopd t0: [18:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [18:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [15:00:00 22/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 120 vu: ml t0: [16:00:00 22/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 120 vu: ml t0: [18:00:00 22/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 50 vu: ml
t0: [23:00:00 22/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 250 ap: none
t0: [20:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 22/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 22/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [20:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 22/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 22/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 22/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 22/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 22/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 22/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [20:00:00 22/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [20:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [20:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 22/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 22/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 22/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 22/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 22/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 22/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 22/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [20:00:00 22/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 22/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [20:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 85.6667 u1: mmHg st: NotStopd t0: [20:00:00 22/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 22/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [20:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 22/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 56 u1: BPM st: NotStopd t0: [20:00:00 22/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 22/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 22/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 22/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 22/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 22/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 22/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [20:00:00 22/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 22/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 22/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [20:00:00 22/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [20:00:00 22/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [20:00:00 22/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [20:00:00 22/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [20:00:00 22/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [20:00:00 22/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [20:00:00 22/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [23:00:00 22/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 820 ap: none
t0: [20:20:00 22/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:20:00 22/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:20:00 22/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:20:00 22/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [20:20:00 22/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:20:00 22/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:20:00 22/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:20:00 22/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:20:00 22/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:20:00 22/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:20:00 22/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [20:20:00 22/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.3 u1: L/min st: NotStopd t0: [20:20:00 22/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:20:00 22/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:20:00 22/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 28 u1: . st: NotStopd t0: [20:20:00 22/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [20:20:00 22/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [20:20:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 100 u1: % st: NotStopd t0: [20:20:00 22/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:20:00 22/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:20:00 22/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 381 u1: ml/B st: NotStopd t0: [20:20:00 22/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:20:00 22/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:20:00 22/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:20:00 22/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:20:00 22/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:20:00 22/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [21:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 148 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [21:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [21:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [21:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [21:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
id: Tube Feeding el: 1 cu: MICU cg: RN io: Tube Feeding PO/Gastric du: ml rt: Gastric/Feeding Tube
t0: [22:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [22:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [22:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89.6667 u1: mmHg st: NotStopd t0: [22:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [22:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [22:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 22/02/2016] id: Tube Feeding PO/Gastric el: 1 cu: MICU cg: RN ai: 498 vo: 0 vu: ml nb: 1
t0: [23:00:00 22/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 22/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 22/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 22/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 22/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 22/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [23:00:00 22/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 22/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 120 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [23:00:00 22/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.3333 u1: mmHg st: NotStopd t0: [23:00:00 22/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 22/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [23:00:00 22/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [23:00:00 22/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [20:20:00 22/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:20:00 22/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 23/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 23/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 23/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 23/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 23/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [00:00:00 23/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 23/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 23/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 23/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 23/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 23/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 23/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 23/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 23/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.9 u1: L/min st: NotStopd t0: [00:00:00 23/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:00:00 23/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 23/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 28 u1: . st: NotStopd t0: [00:00:00 23/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [00:00:00 23/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [00:00:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [00:00:00 23/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 376 u1: ml/B st: NotStopd t0: [00:00:00 23/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 23/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 23/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 23/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 23/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 23/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 22/02/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 22/02/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [20:00:00 22/02/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 22/02/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 22/02/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [22:00:00 22/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [23:00:00 22/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 23/02/2016] id: Range of Motion el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 23/02/2016] id: Circulation/SkinInt el: 0 cu: MICU cg: RN v1: Circulation Adeq st: NotStopd t0: [00:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 23/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [00:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 23/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [00:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 23/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 23/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [00:00:00 23/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [00:00:00 23/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Feeding st: NotStopd t0: [00:00:00 23/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [00:00:00 23/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [00:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [00:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 23/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 23/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 23/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 23/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [00:00:00 23/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 23/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 23/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [00:00:00 23/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 23/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 23/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 23/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [00:00:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83 u1: mmHg st: NotStopd t0: [00:00:00 23/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 23/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [00:00:00 23/02/2016] id: Position Change el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 23/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 23/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 23/02/2016] id: Removed x 5 Mins el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 23/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [00:00:00 23/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 23/02/2016] id: Restraints Evaluated el: 0 cu: MICU cg: RN v1: Behavior Conts st: NotStopd t0: [00:00:00 23/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 23/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [00:00:00 23/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [00:00:00 23/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 23/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Axillary st: NotStopd t0: [00:00:00 23/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.3889 u1: Deg. C st: NotStopd t0: [00:00:00 23/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 97.5 u1: Deg. F st: NotStopd t0: [00:00:00 23/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 23/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [00:00:00 23/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [00:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 23/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [00:00:00 23/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [00:00:00 23/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [00:00:00 23/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [00:00:00 23/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [00:00:00 23/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [00:00:00 23/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 23/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [00:00:00 23/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [23:00:00 22/02/2016] tf: [17:24:00 26/02/2016] dt: 5424 id: Tube Feeding PO/Gastric el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml t0: [00:00:00 23/02/2016] id: Tube Feeding PO/Gastric el: 1 cu: MICU cg: RN ai: 498 vo: 40 vu: ml
t0: [02:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [02:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [02:00:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96.6667 u1: mmHg st: NotStopd t0: [02:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 26 u1: BPM st: NotStopd t0: [02:00:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [04:20:00 23/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:20:00 23/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:20:00 23/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:20:00 23/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:20:00 23/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [04:20:00 23/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:20:00 23/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:20:00 23/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:20:00 23/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:20:00 23/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:20:00 23/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:20:00 23/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:20:00 23/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 15 u1: cmH2O st: NotStopd t0: [04:20:00 23/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.6 u1: L/min st: NotStopd t0: [04:20:00 23/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:20:00 23/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:20:00 23/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 28 u1: . st: NotStopd t0: [04:20:00 23/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 31 u1: BPM st: NotStopd t0: [04:20:00 23/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [04:20:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: RRT v1: 99 u1: % st: NotStopd t0: [04:20:00 23/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 360 u1: ml/B st: NotStopd t0: [04:20:00 23/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:20:00 23/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:20:00 23/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:20:00 23/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:20:00 23/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:20:00 23/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [04:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 60 u1: BPM st: NotStopd t0: [04:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [04:00:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [04:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [04:00:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:15:00 23/02/2016] id: Venous CO2(Calc) VBG'S el: 0 cu: MICU cg: 1663 v1: 30 rs: Final st: NotStopd t0: [05:15:00 23/02/2016] id: Venous PvCO2 VBG's el: 0 cu: MICU cg: 1663 v1: 44 u1: mmHg rs: Final st: NotStopd t0: [05:15:00 23/02/2016] id: Venous PvO2 Mixed Venous Gases el: 0 cu: MICU cg: 1663 v1: 29 u1: mmHg rs: Final st: NotStopd t0: [05:15:00 23/02/2016] id: Venous pH VBG's el: 0 cu: MICU cg: 1663 v1: 7.43 u1: pH rs: Final st: NotStopd
t0: [05:00:00 23/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.6 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 13.6 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 29.8 u1: % rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.5 u1: gm/dl rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 392 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.35 u1: /mic l rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.6 rs: Final st: NotStopd
t0: [03:00:00 23/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Yellow v2: Thick st: NotStopd t0: [03:00:00 23/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Scant st: NotStopd
t0: [05:00:00 23/02/2016] id: Tube Feeding PO/Gastric el: 1 cu: MICU cg: RN ai: 498 vo: 200 vu: ml
t0: [06:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 23/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [06:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 23/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [06:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 23/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [06:00:00 23/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [06:00:00 23/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [06:00:00 23/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [06:00:00 23/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [06:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [06:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 23/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [06:00:00 23/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [06:00:00 23/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [06:00:00 23/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 23/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 23/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [06:00:00 23/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [06:00:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 122 u1: mmHg v2: 60 u2: mmHg st: NotStopd t0: [06:00:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 80.6667 u1: mmHg st: NotStopd t0: [06:00:00 23/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [06:00:00 23/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [06:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 23/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 23/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [06:00:00 23/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [06:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [06:00:00 23/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 23/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [06:00:00 23/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [06:00:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 23/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [06:00:00 23/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [06:00:00 23/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [06:00:00 23/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [06:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [06:00:00 23/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [06:00:00 23/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [06:00:00 23/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Potential Prob st: NotStopd t0: [06:00:00 23/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Very Limited st: NotStopd t0: [06:00:00 23/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [06:00:00 23/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd
t0: [05:00:00 23/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 95 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 89 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 2.8 u1: mEq/L rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 127 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 21 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 27 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 95 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 89 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 2 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 2.8 u1: mEq/L rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [05:00:00 23/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 127 rs: Final st: NotStopd
t0: [08:00:00 23/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: rrt v1: 1 v2: 23 st: NotStopd t0: [08:00:00 23/02/2016] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 23/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 45 u1: cmH2O st: NotStopd t0: [08:00:00 23/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 45 u1: BPM st: NotStopd t0: [08:00:00 23/02/2016] id: Airway Size el: 0 cu: MICU cg: rrt v1: 8.0 mm st: NotStopd t0: [08:00:00 23/02/2016] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [08:00:00 23/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 23/02/2016] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 12 v2: 23 st: NotStopd t0: [08:00:00 23/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 4 st: NotStopd t0: [08:00:00 23/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 23/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 23/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: rrt v1: 14 u1: cmH2O st: NotStopd t0: [08:00:00 23/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 12.4 u1: L/min st: NotStopd t0: [08:00:00 23/02/2016] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 8 u1: cmH2O st: NotStopd t0: [08:00:00 23/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [08:00:00 23/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 28 u1: . st: NotStopd t0: [08:00:00 23/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 33 u1: BPM st: NotStopd t0: [08:00:00 23/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 4 u1: cmH2O st: NotStopd t0: [08:00:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: rrt v1: 100 u1: % st: NotStopd t0: [08:00:00 23/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: rrt v1: 383 u1: ml/B st: NotStopd t0: [08:00:00 23/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: rrt v1: Yes v2: No st: NotStopd t0: [08:00:00 23/02/2016] id: Trach Size el: 0 cu: MICU cg: rrt v1: #8 st: NotStopd t0: [08:00:00 23/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: rrt v1: Portex st: NotStopd t0: [08:00:00 23/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [08:00:00 23/02/2016] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
t0: [08:00:00 23/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: rrt v1: Yellow v2: Thick st: NotStopd t0: [08:00:00 23/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: rrt v1: Suctioned v2: Small st: NotStopd
t0: [08:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 23/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 23/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Carafate st: NotStopd t0: [08:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 23/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [08:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 23/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 23/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 23/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [08:00:00 23/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 23/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [08:00:00 23/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [08:00:00 23/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [08:00:00 23/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [08:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 23/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 23/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 23/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 23/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 23/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [08:00:00 23/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [08:00:00 23/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 23/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [08:00:00 23/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 23/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 23/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [08:00:00 23/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 23/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Steri-strip v2: Clean and Dry st: NotStopd t0: [08:00:00 23/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [08:00:00 23/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 23/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 23/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 23/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [08:00:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 89 u1: mmHg st: NotStopd t0: [08:00:00 23/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 23/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 23/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 23/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 23/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 23/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 23/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 23/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [08:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [08:00:00 23/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 23/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 23/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 23/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 23/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 23/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 23/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [08:00:00 23/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [08:00:00 23/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 23/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 23/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 23/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [08:00:00 23/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [08:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 23/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 23/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [08:00:00 23/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 23/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 23/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 23/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 23/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [08:00:00 23/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:00:00 23/02/2016] id: Tube Feeding PO/Gastric el: 1 cu: MICU cg: RN ai: 498 vo: 120 vu: ml
t0: [23:00:00 23/02/2016] dt: 24 id: Tube Feeds In Total el: 2 cu: MICU cg: RN cv: 360 ap: none
t0: [10:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [10:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [10:00:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [10:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 23/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 240 vu: ml
tf: [09:00:00 23/02/2016] pt: Unit Dose rt: PO fr: Q12H fs: 10, 22 dn: 2 m1: Pantoprazole v1: 40 u1: mg tf: [09:00:00 25/02/2016] pt: Unit Dose rt: NG fr: BID fs: 10, 22 dn: 2 m1: Lansoprazole Oral Suspension v1: 30 u1: mg tf: [21:00:00 26/02/2016] pt: Unit Dose rt: PR fr: QD fs: 10 dn: 1 m1: Bisacodyl (Rectal) v1: 10 u1: mg
t0: [10:00:00 23/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 23/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 23/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [10:00:00 23/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:30:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:30:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:30:00 23/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [11:30:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:30:00 23/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [11:30:00 23/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:30:00 23/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [11:30:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [11:30:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:30:00 23/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [11:30:00 23/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [11:30:00 23/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [11:30:00 23/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:30:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 162 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [11:30:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 103.333 u1: mmHg st: NotStopd t0: [11:30:00 23/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: None/Remarks st: NotStopd t0: [11:30:00 23/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [11:30:00 23/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:30:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:30:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 42 u1: BPM st: NotStopd t0: [11:30:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [11:30:00 23/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [11:30:00 23/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [11:30:00 23/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [11:30:00 23/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [11:30:00 23/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [11:30:00 23/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [11:30:00 23/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [11:30:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 23/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 25 u1: . st: NotStopd t0: [12:00:00 23/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: rrt v1: 1 v2: 23 st: NotStopd t0: [12:00:00 23/02/2016] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.3 u1: torr st: NotStopd t0: [12:00:00 23/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 45 u1: cmH2O st: NotStopd t0: [12:00:00 23/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 45 u1: BPM st: NotStopd t0: [12:00:00 23/02/2016] id: Airway Size el: 0 cu: MICU cg: rrt v1: 8.0 mm st: NotStopd t0: [12:00:00 23/02/2016] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [12:00:00 23/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 35 u1: Deg. C st: NotStopd t0: [12:00:00 23/02/2016] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 12 v2: 23 st: NotStopd t0: [12:00:00 23/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 4 st: NotStopd t0: [12:00:00 23/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Albuterol st: NotStopd t0: [12:00:00 23/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Atrovent st: NotStopd t0: [12:00:00 23/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: rrt v1: 14 u1: cmH2O st: NotStopd t0: [12:00:00 23/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 11.5 u1: L/min st: NotStopd t0: [12:00:00 23/02/2016] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 8 u1: cmH2O st: NotStopd t0: [12:00:00 23/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [12:00:00 23/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 25 u1: . st: NotStopd t0: [12:00:00 23/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 32 u1: BPM st: NotStopd t0: [12:00:00 23/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 4 u1: cmH2O st: NotStopd t0: [12:00:00 23/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: rrt v1: 374 u1: ml/B st: NotStopd t0: [12:00:00 23/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: rrt v1: Yes v2: No st: NotStopd t0: [12:00:00 23/02/2016] id: Trach Size el: 0 cu: MICU cg: rrt v1: #8 st: NotStopd t0: [12:00:00 23/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: rrt v1: Portex st: NotStopd t0: [12:00:00 23/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [12:00:00 23/02/2016] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
t0: [12:00:00 23/02/2016] id: Stool Management el: 0 cu: MICU cg: -1 st: D/C'd
t0: [12:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 23/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 23/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [12:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 23/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 23/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [12:00:00 23/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [12:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [12:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 23/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [12:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 44 u1: BPM st: NotStopd t0: [12:00:00 23/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Soft st: NotStopd t0: [12:00:00 23/02/2016] id: Stool Guaiac el: 0 cu: MICU cg: RN v1: Negative st: NotStopd t0: [12:00:00 23/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [12:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 23/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [13:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 23/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [13:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [13:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [13:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 23/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 240 vu: ml
t0: [13:07:00 23/02/2016] id: Venous CO2(Calc) VBG'S el: 0 cu: MICU cg: 1663 v1: 31 rs: Final st: NotStopd t0: [13:07:00 23/02/2016] id: Venous PvCO2 VBG's el: 0 cu: MICU cg: 1663 v1: 50 u1: mmHg rs: Final st: NotStopd t0: [13:07:00 23/02/2016] id: Venous PvO2 Mixed Venous Gases el: 0 cu: MICU cg: 1663 v1: 39 u1: mmHg rs: Final st: NotStopd t0: [13:07:00 23/02/2016] id: Venous pH VBG's el: 0 cu: MICU cg: 1663 v1: 7.39 u1: pH rs: Final st: NotStopd
t0: [14:45:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:45:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:45:00 23/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:45:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:45:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:45:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:45:00 23/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [14:45:00 23/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:45:00 23/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [14:45:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [14:45:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:45:00 23/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [14:45:00 23/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [14:45:00 23/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:45:00 23/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:45:00 23/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:45:00 23/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:45:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:45:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 44 u1: BPM st: NotStopd t0: [14:45:00 23/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [14:45:00 23/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [14:45:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 170 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [13:00:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 107.333 u1: mmHg st: NotStopd t0: [14:45:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 171 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [14:45:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 107.667 u1: mmHg st: NotStopd
t0: [15:00:00 23/02/2016] id: Inc Dsg/Status #2 el: 0 cu: MICU cg: -1 st: D/C'd
t0: [15:00:00 23/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: rrt v1: 1 v2: 23 st: NotStopd t0: [15:00:00 23/02/2016] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.3 u1: torr st: NotStopd t0: [15:00:00 23/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 45 u1: cmH2O st: NotStopd t0: [15:00:00 23/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 45 u1: BPM st: NotStopd t0: [15:00:00 23/02/2016] id: Airway Size el: 0 cu: MICU cg: rrt v1: 8.0 mm st: NotStopd t0: [15:00:00 23/02/2016] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [15:00:00 23/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 35 u1: Deg. C st: NotStopd t0: [15:00:00 23/02/2016] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 12 v2: 23 st: NotStopd t0: [15:00:00 23/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 4 st: NotStopd t0: [15:00:00 23/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Albuterol st: NotStopd t0: [15:00:00 23/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Atrovent st: NotStopd t0: [15:00:00 23/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: rrt v1: 14 u1: cmH2O st: NotStopd t0: [15:00:00 23/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 10.74 u1: L/min st: NotStopd t0: [15:00:00 23/02/2016] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 8 u1: cmH2O st: NotStopd t0: [15:00:00 23/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [15:00:00 23/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 25 u1: . st: NotStopd t0: [15:00:00 23/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 30 u1: BPM st: NotStopd t0: [15:00:00 23/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 4 u1: cmH2O st: NotStopd t0: [15:00:00 23/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: rrt v1: 358 u1: ml/B st: NotStopd t0: [15:00:00 23/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: rrt v1: Yes v2: No st: NotStopd t0: [15:00:00 23/02/2016] id: Trach Size el: 0 cu: MICU cg: rrt v1: #8 st: NotStopd t0: [15:00:00 23/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: rrt v1: Portex st: NotStopd t0: [15:00:00 23/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [15:00:00 23/02/2016] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
t0: [15:00:00 23/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [15:00:00 23/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 23/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 23/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 23/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [16:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 23/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 23/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [16:00:00 23/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 23/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [16:00:00 23/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [16:00:00 23/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [16:00:00 23/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [16:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 23/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 23/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 23/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 23/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [16:00:00 23/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [16:00:00 23/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [16:00:00 23/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 23/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [16:00:00 23/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 23/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: Serous v2: Scant st: NotStopd t0: [16:00:00 23/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 23/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [16:00:00 23/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 23/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: RN v1: Healed v2: Clean and Dry st: NotStopd t0: [16:00:00 23/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 23/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: RN v1: Sternum st: NotStopd t0: [16:00:00 23/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 23/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 23/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 23/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [16:00:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 99 u1: mmHg st: NotStopd t0: [16:00:00 23/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 23/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 23/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: None/Remarks v2: Off st: NotStopd t0: [16:00:00 23/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [16:00:00 23/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 23/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 23/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 23/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [16:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 46 u1: BPM st: NotStopd t0: [16:00:00 23/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 23/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 23/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 23/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [16:00:00 23/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 23/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 23/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [16:00:00 23/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [16:00:00 23/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 23/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 23/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 23/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [16:00:00 23/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 23/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 23/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [16:00:00 23/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [16:00:00 23/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [16:00:00 23/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [16:00:00 23/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 23/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [16:00:00 23/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [16:00:00 23/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [16:00:00 23/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [23:00:00 23/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 250 ap: none
tf: [15:00:00 24/02/2016] pt: Unit Dose rt: IV fr: ONCE fs: 16 dn: 1 m1: Alteplase (Catheter Clearance) v1: 1 u1: mg
t0: [16:01:00 23/02/2016] id: Inc Closure/Appear#2 el: 0 cu: MICU cg: -1 st: D/C'd t0: [16:01:00 23/02/2016] id: Inc Drainage/Amt #2 el: 0 cu: MICU cg: -1 st: D/C'd t0: [16:01:00 23/02/2016] id: Incision/Wound #2 el: 0 cu: MICU cg: -1 st: D/C'd
t0: [18:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 23/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 23/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [18:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 23/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [18:00:00 23/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 28 st: NotStopd t0: [18:00:00 23/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: RN v1: 14 French st: NotStopd t0: [18:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [18:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 158 u1: mmHg v2: 73 u2: mmHg st: NotStopd t0: [18:00:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 101.333 u1: mmHg st: NotStopd t0: [18:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 23/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [18:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 39 u1: BPM st: NotStopd t0: [18:00:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [18:00:00 23/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Indwelling Cath st: NotStopd t0: [18:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 23/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 120 vu: ml t0: [18:00:00 23/02/2016] tf: [17:24:00 26/02/2016] dt: 4284 id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 110 vu: ml
t0: [20:00:00 23/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 23/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 23/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 23/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 23/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [20:00:00 23/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 23/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 23/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 23/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 23/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 23/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 23/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 23/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 23/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 13 u1: L/min st: NotStopd t0: [20:00:00 23/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:00:00 23/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 22 st: NotStopd t0: [20:00:00 23/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [20:00:00 23/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [20:00:00 23/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [20:00:00 23/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 23/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [20:00:00 23/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 428 u1: ml/B st: NotStopd t0: [20:00:00 23/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 23/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 23/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 23/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 23/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 23/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 23/02/2016] id: GU Cath Insert Date el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 23/02/2016] id: GU Catheter Size el: 0 cu: MICU cg: -1 st: D/C'd
t0: [20:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 23/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 23/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [20:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 23/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [20:00:00 23/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 23/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 23/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 23/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [20:00:00 23/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [20:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 65 u1: BPM st: NotStopd t0: [20:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 23/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 23/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 23/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 23/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 23/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 23/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 23/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 23/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 23/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 23/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 23/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [20:00:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 91 u1: mmHg st: NotStopd t0: [20:00:00 23/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 23/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 23/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 23/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 23/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [20:00:00 23/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 23/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 23/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 23/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 23/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 23/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 23/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 23/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37 u1: Deg. C st: NotStopd t0: [20:00:00 23/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.6 u1: Deg. F st: NotStopd t0: [20:00:00 23/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [20:00:00 23/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 23/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [20:00:00 23/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 23/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 128 rs: Final st: NotStopd t0: [20:00:00 23/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 128 rs: Final st: NotStopd
t0: [22:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [22:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 23/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 96 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [22:00:00 23/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 68 u1: mmHg st: NotStopd t0: [22:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [22:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [23:00:00 23/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 23/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 23/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 23/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 23/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 23/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [23:00:00 23/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 23/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 23/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [23:00:00 23/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [23:30:00 23/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [23:30:00 23/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [23:30:00 23/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [23:30:00 23/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [23:30:00 23/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: RN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [23:30:00 23/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: RN v1: Clamped st: NotStopd t0: [23:30:00 23/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [23:30:00 23/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [23:30:00 23/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [23:30:00 23/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [23:30:00 23/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [23:30:00 23/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [23:30:00 23/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [23:30:00 23/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [23:30:00 23/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [23:30:00 23/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [23:30:00 23/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [23:30:00 23/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [23:30:00 23/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [23:30:00 23/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [23:30:00 23/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [23:30:00 23/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [23:30:00 23/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [23:30:00 23/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [23:30:00 23/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [23:30:00 23/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [23:30:00 23/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [23:30:00 23/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [23:30:00 23/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [23:30:00 23/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:30:00 23/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [23:30:00 23/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [23:30:00 23/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [23:30:00 23/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [23:30:00 23/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [23:30:00 23/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [23:30:00 23/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [23:30:00 23/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [23:30:00 23/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [23:30:00 23/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [23:30:00 23/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Anxious st: NotStopd t0: [23:30:00 23/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [23:00:00 23/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [23:00:00 23/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN pv: 100 cv: 100 ap: none t0: [23:00:00 23/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN pv: -40 cv: -40 ap: none t0: [23:00:00 23/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN pv: 60 cv: 1360 ap: none t0: [23:00:00 23/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN pv: 60 cv: 750 ap: none t0: [23:00:00 23/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN pv: 100 cv: 1135 ap: none t0: [23:00:00 23/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN pv: -40 cv: 225 ap: carryForward t0: [23:00:00 23/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN pv: 100 cv: 1135 ap: carryForward t0: [23:00:00 23/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN pv: -40 cv: 7256.94 ap: carryForward
t0: [00:00:00 24/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 24/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:00:00 24/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 24/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 24/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [00:00:00 24/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 24/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 24/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 24/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 24/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 24/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 24/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 24/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 24/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12 u1: L/min st: NotStopd t0: [00:00:00 24/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:00:00 24/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [00:00:00 24/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 37 u1: BPM st: NotStopd t0: [00:00:00 24/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [00:00:00 24/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [00:00:00 24/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [00:00:00 24/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 357 u1: ml/B st: NotStopd t0: [00:00:00 24/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 24/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 24/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 24/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 24/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 24/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [00:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 143 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [00:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93.6667 u1: mmHg st: NotStopd t0: [00:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 49 u1: BPM st: NotStopd t0: [00:00:00 24/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [00:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [01:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [01:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 45 u1: BPM st: NotStopd t0: [01:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [02:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [02:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 118 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [02:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 80.6667 u1: mmHg st: NotStopd t0: [02:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [02:00:00 24/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [02:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 24/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 24/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 24/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 24/02/2016] id: RSBI Not Completed el: 0 cu: MICU cg: RRT v1: Other/Remarks st: NotStopd t0: [04:00:00 24/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 24/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [04:00:00 24/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [04:00:00 24/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 24/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 24/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 24/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 24/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [04:00:00 24/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 24/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 24/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [04:00:00 24/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.4 u1: L/min st: NotStopd t0: [04:00:00 24/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:00:00 24/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:00:00 24/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 25 u1: . st: NotStopd t0: [04:00:00 24/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 35 u1: BPM st: NotStopd t0: [04:00:00 24/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [04:00:00 24/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 361 u1: ml/B st: NotStopd t0: [04:00:00 24/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 24/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 24/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 24/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 24/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:00:00 24/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [03:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [03:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 47 u1: BPM st: NotStopd t0: [03:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [04:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 24/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 129 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [04:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 83.6667 u1: mmHg st: NotStopd t0: [04:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [04:00:00 24/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [04:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [05:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [05:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [05:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 24/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [06:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [06:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 121 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [06:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 81.6667 u1: mmHg st: NotStopd t0: [06:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 43 u1: BPM st: NotStopd t0: [06:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [07:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [07:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [07:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [07:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [07:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 64 u1: BPM st: NotStopd t0: [07:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [07:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [07:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 42 u1: BPM st: NotStopd t0: [07:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [06:45:00 24/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.6 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 13.6 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 29.4 u1: % rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.6 u1: gm/dl rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 352 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.28 u1: /mic l rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 13.6 rs: Final st: NotStopd
t0: [08:00:00 24/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: rrt v1: 1 v2: 23 st: NotStopd t0: [08:00:00 24/02/2016] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.3 u1: torr st: NotStopd t0: [08:00:00 24/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 45 u1: cmH2O st: NotStopd t0: [08:00:00 24/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 45 u1: BPM st: NotStopd t0: [08:00:00 24/02/2016] id: Airway Size el: 0 cu: MICU cg: rrt v1: 8.0 mm st: NotStopd t0: [08:00:00 24/02/2016] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [08:00:00 24/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 35 u1: Deg. C st: NotStopd t0: [08:00:00 24/02/2016] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 12 v2: 23 st: NotStopd t0: [08:00:00 24/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 4 st: NotStopd t0: [08:00:00 24/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Albuterol st: NotStopd t0: [08:00:00 24/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Atrovent st: NotStopd t0: [08:00:00 24/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: rrt v1: 13 u1: cmH2O st: NotStopd t0: [08:00:00 24/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 12.7 u1: L/min st: NotStopd t0: [08:00:00 24/02/2016] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 8 u1: cmH2O st: NotStopd t0: [08:00:00 24/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [08:00:00 24/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 25 u1: . st: NotStopd t0: [08:00:00 24/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 34 u1: BPM st: NotStopd t0: [08:00:00 24/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 4 u1: cmH2O st: NotStopd t0: [08:00:00 24/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: rrt v1: Tan v2: Thick st: NotStopd t0: [08:00:00 24/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: rrt v1: Suctioned v2: Moderate st: NotStopd t0: [08:00:00 24/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: rrt v1: 354 u1: ml/B st: NotStopd t0: [08:00:00 24/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: rrt v1: Yes v2: No st: NotStopd t0: [08:00:00 24/02/2016] id: Trach Size el: 0 cu: MICU cg: rrt v1: #8 st: NotStopd t0: [08:00:00 24/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: rrt v1: Portex st: NotStopd t0: [08:00:00 24/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [08:00:00 24/02/2016] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
t0: [07:00:00 24/02/2016] id: Alarms el: 0 cu: MICU cg: SRN v1: ON st: NotStopd t0: [07:00:00 24/02/2016] id: Parameters Checked el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [07:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 138 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [07:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 90.6667 u1: mmHg st: NotStopd t0: [07:00:00 24/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: SRN v1: 36.6667 u1: Deg. C st: NotStopd t0: [07:00:00 24/02/2016] id: Temperature F el: 0 cu: MICU cg: SRN v1: 98 u1: Deg. F st: NotStopd t0: [08:00:00 24/02/2016] id: Pain Present el: 0 cu: MICU cg: SRN v1: No st: NotStopd t0: [08:00:00 24/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: SRN v1: Pt Verbalized st: NotStopd t0: [08:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [08:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [08:00:00 24/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: SRN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 24/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: SRN v1: No/Not Sedated st: NotStopd t0: [08:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [08:00:00 24/02/2016] id: Diet Type el: 0 cu: MICU cg: SRN v1: Soft Solid st: NotStopd t0: [08:00:00 24/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: SRN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [08:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [08:00:00 24/02/2016] id: Eye Opening el: 0 cu: MICU cg: SRN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 24/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: SRN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [08:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 63 u1: BPM st: NotStopd t0: [08:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [08:00:00 24/02/2016] id: Height of Bed el: 0 cu: MICU cg: SRN v1: 15 degrees st: NotStopd t0: [08:00:00 24/02/2016] id: Level of Conscious el: 0 cu: MICU cg: SRN v1: Alert st: NotStopd t0: [08:00:00 24/02/2016] id: Motor Response el: 0 cu: MICU cg: SRN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 138 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [08:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 90.6667 u1: mmHg st: NotStopd t0: [08:00:00 24/02/2016] id: Orientation el: 0 cu: MICU cg: SRN v1: Oriented x 3 st: NotStopd t0: [08:00:00 24/02/2016] id: Pain Location el: 0 cu: MICU cg: SRN v1: Not Indicated st: NotStopd t0: [08:00:00 24/02/2016] id: Pain Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [08:00:00 24/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: SRN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [08:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [08:00:00 24/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: SRN v1: Diminished st: NotStopd t0: [08:00:00 24/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: SRN v1: Clear st: NotStopd t0: [08:00:00 24/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: SRN v1: Tachypneic st: NotStopd t0: [08:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 36 u1: BPM st: NotStopd t0: [08:00:00 24/02/2016] id: Urine Source el: 0 cu: MICU cg: SRN v1: Condom Catheter st: NotStopd t0: [08:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [07:00:00 24/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: SRN vo: 320 vu: ml
t0: [08:00:00 24/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: SRN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 24/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: SRN v1: Clamped st: NotStopd t0: [08:00:00 24/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: SRN v1: Soft Distended st: NotStopd t0: [08:00:00 24/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: SRN v1: Clear st: NotStopd t0: [08:00:00 24/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: SRN v1: Clear st: NotStopd t0: [08:00:00 24/02/2016] id: Oral Cavity el: 0 cu: MICU cg: SRN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 24/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: SRN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 24/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: SRN v1: Present st: NotStopd
t0: [08:00:00 24/02/2016] id: HOB el: 0 cu: MICU cg: SRN v1: 15 degrees st: NotStopd t0: [08:00:00 24/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: SRN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 24/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: SRN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 24/02/2016] id: Activity el: 0 cu: MICU cg: SRN v1: Bedrest st: NotStopd t0: [08:00:00 24/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: SRN v1: Good st: NotStopd t0: [08:00:00 24/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: SRN v1: Duoderm st: NotStopd t0: [08:00:00 24/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: SRN v1: Coccyx st: NotStopd t0: [08:00:00 24/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: SRN v1: Compress Sleeves v2: On st: NotStopd t0: [08:00:00 24/02/2016] id: Position el: 0 cu: MICU cg: SRN v1: Supine st: NotStopd t0: [08:00:00 24/02/2016] id: Assistance Device el: 0 cu: MICU cg: SRN v1: 1 Person Assist st: NotStopd t0: [08:00:00 24/02/2016] id: Restraint Location el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [08:00:00 24/02/2016] id: Side Rails el: 0 cu: MICU cg: SRN v1: Side Rails Up st: NotStopd t0: [08:00:00 24/02/2016] id: Skin Integrity el: 0 cu: MICU cg: SRN v1: Impaired st: NotStopd t0: [08:00:00 24/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: SRN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 24/02/2016] id: Support Systems el: 0 cu: MICU cg: SRN v1: Spouse st: NotStopd t0: [08:00:00 24/02/2016] id: Turn el: 0 cu: MICU cg: SRN v1: Back st: NotStopd t0: [08:00:00 24/02/2016] id: Behavior el: 0 cu: MICU cg: SRN v1: Calm st: NotStopd t0: [08:00:00 24/02/2016] id: Braden Activity el: 0 cu: MICU cg: SRN v1: Bedfast st: NotStopd t0: [08:00:00 24/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: SRN v1: Potential Prob st: NotStopd t0: [08:00:00 24/02/2016] id: Braden Mobility el: 0 cu: MICU cg: SRN v1: Very Limited st: NotStopd t0: [08:00:00 24/02/2016] id: Braden Moisture el: 0 cu: MICU cg: SRN v1: Occ. Moist st: NotStopd t0: [08:00:00 24/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: SRN v1: Prob. Inadequate st: NotStopd t0: [08:00:00 24/02/2016] id: Braden Score el: 0 cu: MICU cg: SRN v1: 13 u1: number st: NotStopd t0: [08:00:00 24/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: SRN v1: Sl. Limited st: NotStopd
t0: [06:45:00 24/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.8 u1: mg/dl rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 93 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 86 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.2 u1: mEq/L rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 128 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.8 u1: mg/dl rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 93 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.8 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 86 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.9 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.2 u1: mEq/L rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.3 rs: Final st: NotStopd t0: [06:45:00 24/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 128 rs: Final st: NotStopd
t0: [09:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [09:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [09:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [09:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [09:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [09:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 65 u1: BPM st: NotStopd t0: [09:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [09:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [09:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 35 u1: BPM st: NotStopd t0: [09:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [09:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 142 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [09:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 90 u1: mmHg st: NotStopd
t0: [09:00:00 24/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: SRN vo: 170 vu: ml
t0: [10:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [10:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [10:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [10:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [10:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [10:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 61 u1: BPM st: NotStopd t0: [10:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [10:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 140 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [10:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 94 u1: mmHg st: NotStopd t0: [10:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [10:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 35 u1: BPM st: NotStopd t0: [10:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 24/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: SRN vo: 27 vu: ml
t0: [11:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [11:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [11:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [11:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [11:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [11:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 71 u1: BPM st: NotStopd t0: [11:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [11:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 143 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [11:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 86.3333 u1: mmHg st: NotStopd t0: [11:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [11:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 32 u1: BPM st: NotStopd t0: [11:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [11:25:00 24/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: rrt v1: 1 v2: 23 st: NotStopd t0: [11:25:00 24/02/2016] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.3 u1: torr st: NotStopd t0: [11:25:00 24/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 45 u1: cmH2O st: NotStopd t0: [11:25:00 24/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 45 u1: BPM st: NotStopd t0: [11:25:00 24/02/2016] id: Airway Size el: 0 cu: MICU cg: rrt v1: 8.0 mm st: NotStopd t0: [11:25:00 24/02/2016] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [11:25:00 24/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 35 u1: Deg. C st: NotStopd t0: [11:25:00 24/02/2016] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 12 v2: 23 st: NotStopd t0: [11:25:00 24/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 4 st: NotStopd t0: [11:25:00 24/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Albuterol st: NotStopd t0: [11:25:00 24/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Atrovent st: NotStopd t0: [11:25:00 24/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: rrt v1: 13 u1: cmH2O st: NotStopd t0: [11:25:00 24/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 10.1 u1: L/min st: NotStopd t0: [11:25:00 24/02/2016] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 8 u1: cmH2O st: NotStopd t0: [11:25:00 24/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [11:25:00 24/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 22 u1: . st: NotStopd t0: [11:25:00 24/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 31 u1: BPM st: NotStopd t0: [11:25:00 24/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 4 u1: cmH2O st: NotStopd t0: [11:25:00 24/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: rrt v1: 320 u1: ml/B st: NotStopd t0: [11:25:00 24/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: rrt v1: Yes v2: No st: NotStopd t0: [11:25:00 24/02/2016] id: Trach Size el: 0 cu: MICU cg: rrt v1: #8 st: NotStopd t0: [11:25:00 24/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: rrt v1: Portex st: NotStopd t0: [11:25:00 24/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [11:25:00 24/02/2016] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
t0: [10:00:00 24/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 22 u1: . st: NotStopd
t0: [11:37:00 24/02/2016] id: Venous CO2(Calc) VBG'S el: 0 cu: MICU cg: 1663 v1: 29 rs: Final st: NotStopd t0: [11:37:00 24/02/2016] id: Venous PvCO2 VBG's el: 0 cu: MICU cg: 1663 v1: 51 u1: mmHg rs: Final st: NotStopd t0: [11:37:00 24/02/2016] id: Venous PvO2 Mixed Venous Gases el: 0 cu: MICU cg: 1663 v1: 43 u1: mmHg rs: Final st: NotStopd t0: [11:37:00 24/02/2016] id: Venous pH VBG's el: 0 cu: MICU cg: 1663 v1: 7.35 u1: pH rs: Final st: NotStopd
t0: [08:00:00 24/02/2016] id: GCS Total el: 0 cu: MICU cg: SRN v1: 11 u1: points st: NotStopd t0: [08:00:00 24/02/2016] id: Verbal Response el: 0 cu: MICU cg: SRN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 24/02/2016] id: Pain Present el: 0 cu: MICU cg: SRN v1: No st: NotStopd t0: [12:00:00 24/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: SRN v1: Pt Verbalized st: NotStopd t0: [12:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [12:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [12:00:00 24/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: SRN v1: Calm/Cooperative st: NotStopd t0: [12:00:00 24/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: SRN v1: No/Not Sedated st: NotStopd t0: [12:00:00 24/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: SRN v1: Proton/Pump/Inhi st: NotStopd t0: [12:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [12:00:00 24/02/2016] id: Diet Type el: 0 cu: MICU cg: SRN v1: Soft Solid st: NotStopd t0: [12:00:00 24/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: SRN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 24/02/2016] id: Eye Opening el: 0 cu: MICU cg: SRN v1: 4 Spontaneously st: NotStopd t0: [12:00:00 24/02/2016] id: GCS Total el: 0 cu: MICU cg: SRN v1: 11 u1: points st: NotStopd t0: [12:00:00 24/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: SRN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [12:00:00 24/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: SRN v1: Clamped st: NotStopd t0: [12:00:00 24/02/2016] id: HOB el: 0 cu: MICU cg: SRN v1: Other/Remarks st: NotStopd t0: [12:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 71 u1: BPM st: NotStopd t0: [12:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [12:00:00 24/02/2016] id: Height of Bed el: 0 cu: MICU cg: SRN v1: Other/Remarks st: NotStopd t0: [12:00:00 24/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: SRN v1: PICC line v2: Left Antecub st: NotStopd t0: [12:00:00 24/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: SRN v1: 1 v2: 30 st: NotStopd t0: [12:00:00 24/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: SRN v1: WNL st: NotStopd t0: [12:00:00 24/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: SRN v1: Soft Distended st: NotStopd t0: [12:00:00 24/02/2016] id: Activity el: 0 cu: MICU cg: SRN v1: Chair st: NotStopd t0: [12:00:00 24/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: SRN v1: Good st: NotStopd t0: [12:00:00 24/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: SRN v1: Duoderm st: NotStopd t0: [12:00:00 24/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: SRN v1: Coccyx st: NotStopd t0: [12:00:00 24/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [12:00:00 24/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [12:00:00 24/02/2016] id: Level of Conscious el: 0 cu: MICU cg: SRN v1: Alert st: NotStopd t0: [12:00:00 24/02/2016] id: Motor Response el: 0 cu: MICU cg: SRN v1: 6 Obeys Commands st: NotStopd t0: [12:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 153 u1: mmHg v2: 74 u2: mmHg st: NotStopd t0: [12:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 100.333 u1: mmHg st: NotStopd t0: [12:00:00 24/02/2016] id: Oral Cavity el: 0 cu: MICU cg: SRN v1: Teeth/Tissue WNL st: NotStopd t0: [12:00:00 24/02/2016] id: Orientation el: 0 cu: MICU cg: SRN v1: Oriented x 3 st: NotStopd t0: [12:00:00 24/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: SRN v1: Compress Sleeves v2: On st: NotStopd t0: [12:00:00 24/02/2016] id: Pain Location el: 0 cu: MICU cg: SRN v1: Not Indicated st: NotStopd t0: [12:00:00 24/02/2016] id: Pain Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 24/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: SRN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [12:00:00 24/02/2016] id: Assistance Device el: 0 cu: MICU cg: SRN v1: 2 Person Assist st: NotStopd t0: [12:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [12:00:00 24/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: SRN v1: Diminished st: NotStopd t0: [12:00:00 24/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [12:00:00 24/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: SRN v1: Tachypneic st: NotStopd t0: [12:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 39 u1: BPM st: NotStopd t0: [12:00:00 24/02/2016] id: Restraint Location el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [12:00:00 24/02/2016] id: Side Rails el: 0 cu: MICU cg: SRN v1: Side Rails Up st: NotStopd t0: [12:00:00 24/02/2016] id: Skin Integrity el: 0 cu: MICU cg: SRN v1: Impaired st: NotStopd t0: [12:00:00 24/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: SRN v1: Warm v2: Dry st: NotStopd t0: [12:00:00 24/02/2016] id: SpO2 el: 0 cu: MICU cg: SRN v1: 98 u1: % st: NotStopd t0: [12:00:00 24/02/2016] id: Support Systems el: 0 cu: MICU cg: SRN v1: Spouse st: NotStopd t0: [12:00:00 24/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: SRN v1: 36.6667 u1: Deg. C st: NotStopd t0: [12:00:00 24/02/2016] id: Temperature F el: 0 cu: MICU cg: SRN v1: 98 u1: Deg. F st: NotStopd t0: [12:00:00 24/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: SRN v1: AirMatt/1st Step st: NotStopd t0: [12:00:00 24/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: SRN v1: Yellow v2: Clear st: NotStopd t0: [12:00:00 24/02/2016] id: Urine Source el: 0 cu: MICU cg: SRN v1: Condom Catheter st: NotStopd t0: [12:00:00 24/02/2016] id: Verbal Response el: 0 cu: MICU cg: SRN v1: 1.0 ET/Trach st: NotStopd t0: [12:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd t0: [12:00:00 24/02/2016] id: Behavior el: 0 cu: MICU cg: SRN v1: Calm st: NotStopd t0: [12:00:00 24/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: SRN v1: Present st: NotStopd t0: [12:00:00 24/02/2016] id: Braden Activity el: 0 cu: MICU cg: SRN v1: Chairfast st: NotStopd t0: [12:00:00 24/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: SRN v1: Potential Prob st: NotStopd t0: [12:00:00 24/02/2016] id: Braden Mobility el: 0 cu: MICU cg: SRN v1: Very Limited st: NotStopd t0: [12:00:00 24/02/2016] id: Braden Moisture el: 0 cu: MICU cg: SRN v1: Occ. Moist st: NotStopd t0: [12:00:00 24/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: SRN v1: Prob. Inadequate st: NotStopd t0: [12:00:00 24/02/2016] id: Braden Score el: 0 cu: MICU cg: SRN v1: 14 u1: number st: NotStopd t0: [12:00:00 24/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: SRN v1: Sl. Limited st: NotStopd
t0: [12:00:00 24/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: SRN vo: 40 vu: ml
t0: [13:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [13:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [13:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [13:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [13:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 78 u1: BPM st: NotStopd t0: [13:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [13:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 161 u1: mmHg v2: 77 u2: mmHg st: NotStopd t0: [13:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 105 u1: mmHg st: NotStopd t0: [13:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [13:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [13:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [08:00:00 24/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 240 vu: ml t0: [12:00:00 24/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 360 vu: ml
t0: [13:00:00 24/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: SRN ai: 103 vo: 240 vu: ml
t0: [23:00:00 24/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: SRN cv: 840 ap: none t0: [23:00:00 24/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: SRN cv: 840 ap: none
t0: [14:00:00 24/02/2016] id: Eye Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [14:00:00 24/02/2016] id: Oral Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [14:00:00 24/02/2016] id: Skin Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [14:00:00 24/02/2016] id: Back Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd
t0: [14:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [14:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [14:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [14:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [14:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [14:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 77 u1: BPM st: NotStopd t0: [14:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [14:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 143 u1: mmHg v2: 86 u2: mmHg st: NotStopd t0: [14:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 105 u1: mmHg st: NotStopd t0: [14:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [14:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 30 u1: BPM st: NotStopd t0: [14:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 24/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: SRN vo: 43 vu: ml
t0: [15:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [15:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [15:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [15:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [15:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [15:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 68 u1: BPM st: NotStopd t0: [15:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [15:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 138 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [15:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 93.3333 u1: mmHg st: NotStopd t0: [15:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [15:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 31 u1: BPM st: NotStopd t0: [15:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [15:30:00 24/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: rrt v1: 1 v2: 23 st: NotStopd t0: [15:30:00 24/02/2016] id: FiO2 Set el: 0 cu: MICU cg: rrt v1: 0.3 u1: torr st: NotStopd t0: [15:30:00 24/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: rrt v1: 45 u1: cmH2O st: NotStopd t0: [15:30:00 24/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: rrt v1: 45 u1: BPM st: NotStopd t0: [15:30:00 24/02/2016] id: Airway Size el: 0 cu: MICU cg: rrt v1: 8.0 mm st: NotStopd t0: [15:30:00 24/02/2016] id: Airway Type el: 0 cu: MICU cg: rrt v1: Tracheostomy st: NotStopd t0: [15:30:00 24/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: rrt v1: 35 u1: Deg. C st: NotStopd t0: [15:30:00 24/02/2016] id: Intubation Date el: 0 cu: MICU cg: rrt v1: 12 v2: 23 st: NotStopd t0: [15:30:00 24/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: rrt v1: 4 st: NotStopd t0: [15:30:00 24/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Albuterol st: NotStopd t0: [15:30:00 24/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: rrt v1: 6 v2: Atrovent st: NotStopd t0: [15:30:00 24/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: rrt v1: 13 u1: cmH2O st: NotStopd t0: [15:30:00 24/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: rrt v1: 10.6 u1: L/min st: NotStopd t0: [15:30:00 24/02/2016] id: PEEP Set el: 0 cu: MICU cg: rrt v1: 8 u1: cmH2O st: NotStopd t0: [15:30:00 24/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: rrt v1: 20 st: NotStopd t0: [15:30:00 24/02/2016] id: Pressure Support el: 0 cu: MICU cg: rrt v1: 22 u1: . st: NotStopd t0: [15:30:00 24/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: rrt v1: 34 u1: BPM st: NotStopd t0: [15:30:00 24/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: rrt v1: 4 u1: cmH2O st: NotStopd t0: [15:30:00 24/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: rrt v1: 349 u1: ml/B st: NotStopd t0: [15:30:00 24/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: rrt v1: Yes v2: No st: NotStopd t0: [15:30:00 24/02/2016] id: Trach Size el: 0 cu: MICU cg: rrt v1: #8 st: NotStopd t0: [15:30:00 24/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: rrt v1: Portex st: NotStopd t0: [15:30:00 24/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: rrt v1: CPAP+PS st: NotStopd t0: [15:30:00 24/02/2016] id: Ventilator Type el: 0 cu: MICU cg: rrt v1: Drager st: NotStopd
t0: [16:00:00 24/02/2016] id: Pain Present el: 0 cu: MICU cg: SRN v1: No st: NotStopd t0: [16:00:00 24/02/2016] id: Pain Assess Method el: 0 cu: MICU cg: SRN v1: Pt Verbalized st: NotStopd t0: [16:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [16:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [16:00:00 24/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: SRN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 24/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: SRN v1: No/Not Sedated st: NotStopd t0: [16:00:00 24/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: SRN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [16:00:00 24/02/2016] id: Diet Type el: 0 cu: MICU cg: SRN v1: Soft Solid st: NotStopd t0: [16:00:00 24/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: SRN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 24/02/2016] id: Eye Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 24/02/2016] id: Eye Opening el: 0 cu: MICU cg: SRN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 24/02/2016] id: GCS Total el: 0 cu: MICU cg: SRN v1: 11 u1: points st: NotStopd t0: [16:00:00 24/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: SRN v1: Feeding/Peditube v2: Right Nare st: NotStopd t0: [16:00:00 24/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: SRN v1: Clamped st: NotStopd t0: [16:00:00 24/02/2016] id: HOB el: 0 cu: MICU cg: SRN v1: 45 degrees st: NotStopd t0: [16:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 74 u1: BPM st: NotStopd t0: [16:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [16:00:00 24/02/2016] id: Height of Bed el: 0 cu: MICU cg: SRN v1: 45 degrees st: NotStopd t0: [16:00:00 24/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: SRN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 24/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: SRN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 24/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: SRN v1: WNL st: NotStopd t0: [16:00:00 24/02/2016] id: Activity el: 0 cu: MICU cg: SRN v1: Bedrest st: NotStopd t0: [16:00:00 24/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: SRN v1: Good st: NotStopd t0: [16:00:00 24/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: SRN v1: Soap & H20 st: NotStopd t0: [16:00:00 24/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: SRN v1: Abrasion st: NotStopd t0: [16:00:00 24/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 24/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: SRN v1: Duoderm st: NotStopd t0: [16:00:00 24/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: SRN v1: Red st: NotStopd t0: [16:00:00 24/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: SRN v1: Coccyx st: NotStopd t0: [16:00:00 24/02/2016] id: Level of Conscious el: 0 cu: MICU cg: SRN v1: Alert st: NotStopd t0: [16:00:00 24/02/2016] id: Motor Response el: 0 cu: MICU cg: SRN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 161 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [16:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 104.333 u1: mmHg st: NotStopd t0: [16:00:00 24/02/2016] id: Oral Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 24/02/2016] id: Oral Cavity el: 0 cu: MICU cg: SRN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 24/02/2016] id: Orientation el: 0 cu: MICU cg: SRN v1: Oriented x 3 st: NotStopd t0: [16:00:00 24/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: SRN v1: None/Remarks st: NotStopd t0: [16:00:00 24/02/2016] id: Pain Location el: 0 cu: MICU cg: SRN v1: Not Indicated st: NotStopd t0: [16:00:00 24/02/2016] id: Pain Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 24/02/2016] id: Position el: 0 cu: MICU cg: SRN v1: Supine st: NotStopd t0: [16:00:00 24/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: SRN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [16:00:00 24/02/2016] id: Assistance Device el: 0 cu: MICU cg: SRN v1: 2 Person Assist st: NotStopd t0: [16:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [16:00:00 24/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: SRN v1: Tachypneic st: NotStopd t0: [16:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 37 u1: BPM st: NotStopd t0: [16:00:00 24/02/2016] id: Restraint Location el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [16:00:00 24/02/2016] id: Side Rails el: 0 cu: MICU cg: SRN v1: Side Rails Up st: NotStopd t0: [16:00:00 24/02/2016] id: Skin Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 24/02/2016] id: Skin Integrity el: 0 cu: MICU cg: SRN v1: Impaired st: NotStopd t0: [16:00:00 24/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: SRN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 24/02/2016] id: SpO2 el: 0 cu: MICU cg: SRN v1: 100 u1: % st: NotStopd t0: [16:00:00 24/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: SRN v1: Brown v2: Soft st: NotStopd t0: [16:00:00 24/02/2016] id: Support Systems el: 0 cu: MICU cg: SRN v1: Spouse st: NotStopd t0: [16:00:00 24/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: SRN v1: 36.4444 u1: Deg. C st: NotStopd t0: [16:00:00 24/02/2016] id: Temperature F el: 0 cu: MICU cg: SRN v1: 97.6 u1: Deg. F st: NotStopd t0: [16:00:00 24/02/2016] id: Turn el: 0 cu: MICU cg: SRN v1: Back st: NotStopd t0: [16:00:00 24/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: SRN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 24/02/2016] id: Urine Source el: 0 cu: MICU cg: SRN v1: Condom Catheter st: NotStopd t0: [16:00:00 24/02/2016] id: Verbal Response el: 0 cu: MICU cg: SRN v1: 1.0 ET/Trach st: NotStopd t0: [16:00:00 24/02/2016] id: Back Care el: 0 cu: MICU cg: SRN v1: Done st: NotStopd t0: [16:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd t0: [16:00:00 24/02/2016] id: Behavior el: 0 cu: MICU cg: SRN v1: Calm st: NotStopd t0: [16:00:00 24/02/2016] id: Braden Activity el: 0 cu: MICU cg: SRN v1: Chairfast st: NotStopd t0: [16:00:00 24/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: SRN v1: Potential Prob st: NotStopd t0: [16:00:00 24/02/2016] id: Braden Mobility el: 0 cu: MICU cg: SRN v1: Very Limited st: NotStopd t0: [16:00:00 24/02/2016] id: Braden Moisture el: 0 cu: MICU cg: SRN v1: Occ. Moist st: NotStopd t0: [16:00:00 24/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: SRN v1: Prob. Inadequate st: NotStopd t0: [16:00:00 24/02/2016] id: Braden Score el: 0 cu: MICU cg: SRN v1: 14 u1: number st: NotStopd t0: [16:00:00 24/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: SRN v1: Sl. Limited st: NotStopd
t0: [16:00:00 24/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: SRN vo: 100 vu: ml
t0: [16:00:00 24/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: SRN v1: Soft Distended st: NotStopd t0: [16:00:00 24/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [16:00:00 24/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [16:00:00 24/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: SRN v1: Diminished st: NotStopd t0: [16:00:00 24/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: SRN v1: Coarse st: NotStopd t0: [16:00:00 24/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: SRN v1: Present st: NotStopd
t0: [17:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [17:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [17:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [17:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [17:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [17:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 73 u1: BPM st: NotStopd t0: [17:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [17:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [17:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 31 u1: BPM st: NotStopd t0: [17:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [17:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 134 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [17:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 92 u1: mmHg st: NotStopd
t0: [18:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [18:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [18:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [18:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [18:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [18:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 75 u1: BPM st: NotStopd t0: [18:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [18:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 142 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [18:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 94 u1: mmHg st: NotStopd t0: [18:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [18:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 45 u1: BPM st: NotStopd t0: [18:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: SRN v1: MICU st: NotStopd t0: [19:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: SRN v1: Full Code st: NotStopd t0: [19:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: SRN v1: Yes st: NotStopd t0: [19:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [19:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: SRN v1: None st: NotStopd t0: [19:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: SRN v1: 73 u1: BPM st: NotStopd t0: [19:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: SRN v1: Normal Sinus st: NotStopd t0: [19:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: SRN v1: 153 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [19:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: SRN v1: 99 u1: mmHg st: NotStopd t0: [19:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: SRN v1: Universal st: NotStopd t0: [19:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: SRN v1: 37 u1: BPM st: NotStopd t0: [19:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: SRN v1: 1 u1: kg st: NotStopd
t0: [19:00:00 24/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: SRN vu: ml
t0: [20:00:00 24/02/2016] id: GI Intub #2/Site el: 0 cu: MICU cg: -1 st: D/C'd t0: [20:00:00 24/02/2016] id: GI#2 Tube Stat/Drain el: 0 cu: MICU cg: -1 st: D/C'd
t0: [20:00:00 24/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 24/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 24/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 24/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 24/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [20:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 24/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 24/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Called st: NotStopd t0: [20:00:00 24/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [20:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 73 u1: BPM st: NotStopd t0: [20:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 24/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 24/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 24/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 24/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 24/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [20:00:00 24/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 24/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 24/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 24/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [20:00:00 24/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 24/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 24/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 24/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 24/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 160 u1: mmHg v2: 81 u2: mmHg st: NotStopd t0: [20:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 107.333 u1: mmHg st: NotStopd t0: [20:00:00 24/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 24/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 24/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 24/02/2016] id: Pain Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 24/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 24/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 24/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [20:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 27 u1: BPM st: NotStopd t0: [20:00:00 24/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 24/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 24/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 24/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 24/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 24/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [20:00:00 24/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [20:00:00 24/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [20:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 24/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 24/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:00:00 24/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:00:00 24/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:00:00 24/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [20:00:00 24/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [20:00:00 24/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:00:00 24/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:00:00 24/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:00:00 24/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:00:00 24/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [20:00:00 24/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [20:00:00 24/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [20:00:00 24/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [20:00:00 24/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11.4 u1: L/min st: NotStopd t0: [20:00:00 24/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:00:00 24/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:00:00 24/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 22 u1: . st: NotStopd t0: [20:00:00 24/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [20:00:00 24/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [20:00:00 24/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [20:00:00 24/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [20:00:00 24/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 407 u1: ml/B st: NotStopd t0: [20:00:00 24/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:00:00 24/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:00:00 24/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:00:00 24/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:00:00 24/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:00:00 24/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [21:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [21:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [21:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [21:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [21:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 76 u1: BPM st: NotStopd t0: [21:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [21:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 151 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [21:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [21:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [21:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [21:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [22:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 75 u1: BPM st: NotStopd t0: [22:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [22:00:00 24/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [22:00:00 24/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7222 u1: Deg. C st: NotStopd t0: [22:00:00 24/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.1 u1: Deg. F st: NotStopd t0: [22:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [22:00:00 24/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 125 vu: ml
t0: [23:00:00 24/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 24/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 24/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 925 ap: none t0: [23:00:00 24/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN cv: -85 ap: none t0: [23:00:00 24/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 925 ap: none t0: [23:00:00 24/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN cv: 7171.94 ap: carryForward
t0: [00:00:00 25/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:00:00 25/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: Positional st: NotStopd t0: [00:00:00 25/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:00:00 25/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 45 u1: cmH2O st: NotStopd t0: [00:00:00 25/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 45 u1: BPM st: NotStopd t0: [00:00:00 25/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:00:00 25/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:00:00 25/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:00:00 25/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:00:00 25/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 4 st: NotStopd t0: [00:00:00 25/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:00:00 25/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:00:00 25/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:00:00 25/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.6 u1: L/min st: NotStopd t0: [00:00:00 25/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [00:00:00 25/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:00:00 25/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 22 u1: . st: NotStopd t0: [00:00:00 25/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 32 u1: BPM st: NotStopd t0: [00:00:00 25/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [00:00:00 25/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 356 u1: ml/B st: NotStopd t0: [00:00:00 25/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:00:00 25/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:00:00 25/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:00:00 25/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:00:00 25/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:00:00 25/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [22:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 110 u1: mmHg v2: 59 u2: mmHg st: NotStopd t0: [22:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 76 u1: mmHg st: NotStopd t0: [23:00:00 24/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [23:00:00 24/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [23:00:00 24/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [23:00:00 24/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 24/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [23:00:00 24/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [23:00:00 24/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [23:00:00 24/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 103 u1: mmHg v2: 56 u2: mmHg st: NotStopd t0: [23:00:00 24/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 71.6667 u1: mmHg st: NotStopd t0: [23:00:00 24/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [23:00:00 24/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 32 u1: BPM st: NotStopd t0: [23:00:00 24/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [00:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 25/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [00:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [00:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [00:00:00 25/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 25/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [00:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [00:00:00 25/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [00:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 95 u1: mmHg v2: 53 u2: mmHg st: NotStopd t0: [00:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 67 u1: mmHg st: NotStopd t0: [01:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [01:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [01:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [01:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [01:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [01:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [01:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [01:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [01:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [01:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 105 u1: mmHg v2: 64 u2: mmHg st: NotStopd t0: [01:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 77.6667 u1: mmHg st: NotStopd t0: [02:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [02:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [02:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 61 u2: mmHg st: NotStopd t0: [02:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 78.6667 u1: mmHg st: NotStopd t0: [02:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [02:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [03:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [03:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [03:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [03:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [03:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [03:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 125 u1: mmHg v2: 68 u2: mmHg st: NotStopd t0: [03:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87 u1: mmHg st: NotStopd t0: [03:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [03:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [03:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [03:00:00 25/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 180 vu: ml
t0: [20:00:00 24/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [20:00:00 24/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Calm st: NotStopd t0: [21:00:00 24/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [21:00:00 24/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [21:00:00 24/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [21:00:00 24/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 24/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: Compress Sleeves v2: On st: NotStopd t0: [21:00:00 24/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 24/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [21:00:00 24/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [21:00:00 24/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [21:00:00 24/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [21:00:00 24/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 25/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [00:00:00 25/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 25/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [00:00:00 25/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 25/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 25/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 25/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [00:00:00 25/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 25/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [00:00:00 25/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 25/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 25/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 25/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 25/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [00:00:00 25/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [00:00:00 25/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [00:00:00 25/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [00:00:00 25/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [00:00:00 25/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [00:00:00 25/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 17 u1: number st: NotStopd t0: [00:00:00 25/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd t0: [02:00:00 25/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [04:00:00 25/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [04:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 25/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 25/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [04:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 25/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [04:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [04:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [04:00:00 25/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 25/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 25/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 25/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 25/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 113 u1: mmHg v2: 62 u2: mmHg st: NotStopd t0: [04:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 79 u1: mmHg st: NotStopd t0: [04:00:00 25/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [04:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 25/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Tachypneic st: NotStopd t0: [04:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [04:00:00 25/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 25/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 25/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 25/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 25/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [04:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [04:00:00 25/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd
t0: [04:00:00 25/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:00:00 25/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:00:00 25/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:00:00 25/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [04:00:00 25/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 20 u1: BPM st: NotStopd t0: [04:00:00 25/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:00:00 25/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:00:00 25/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [04:00:00 25/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:00:00 25/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 45 st: NotStopd t0: [04:00:00 25/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [04:00:00 25/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [04:00:00 25/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [04:00:00 25/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.2 u1: L/min st: NotStopd t0: [04:00:00 25/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [04:00:00 25/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 22 u1: . st: NotStopd t0: [04:00:00 25/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [04:00:00 25/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [04:00:00 25/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 301 u1: ml/B st: NotStopd t0: [04:00:00 25/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:00:00 25/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:00:00 25/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:00:00 25/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:00:00 25/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:00:00 25/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [05:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [05:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [05:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [05:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [05:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [05:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [05:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [05:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 34 u1: BPM st: NotStopd t0: [05:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [05:00:00 25/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [05:00:00 25/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [05:00:00 25/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [05:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 117 u1: mmHg v2: 65 u2: mmHg st: NotStopd t0: [05:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 82.3333 u1: mmHg st: NotStopd t0: [05:00:00 25/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [05:00:00 25/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [05:00:00 25/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [05:00:00 25/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [05:00:00 25/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [05:00:00 25/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [06:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [06:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 83 u2: mmHg st: NotStopd t0: [06:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102.667 u1: mmHg st: NotStopd t0: [06:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 30 u1: BPM st: NotStopd t0: [06:00:00 25/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [06:00:00 25/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.7778 u1: Deg. C st: NotStopd t0: [06:00:00 25/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.2 u1: Deg. F st: NotStopd t0: [06:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 25/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 12.8 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 12.8 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 29 u1: % rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.3 u1: gm/dl rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 388 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.24 u1: /mic l rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 12.8 rs: Final st: NotStopd
t0: [07:00:00 25/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [07:00:00 25/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [07:00:00 25/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [07:00:00 25/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [07:00:00 25/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [07:00:00 25/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [07:00:00 25/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:00:00 25/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:00:00 25/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 45 st: NotStopd t0: [07:00:00 25/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:00:00 25/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:00:00 25/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [07:00:00 25/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9 u1: L/min st: NotStopd t0: [07:00:00 25/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [07:00:00 25/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 22 u1: . st: NotStopd t0: [07:00:00 25/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 29 u1: BPM st: NotStopd t0: [07:00:00 25/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [07:00:00 25/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 358 u1: ml/B st: NotStopd t0: [07:00:00 25/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [07:00:00 25/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [07:00:00 25/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [07:00:00 25/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [07:00:00 25/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [07:00:00 25/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [06:00:00 25/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Calcium Chemistry el: 0 cu: MICU cg: 1663 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 95 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 87 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Phosphorous Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 u1: mEq/L rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.5 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 22 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Calcium (8.4-10.2) Chemistry el: 0 cu: MICU cg: 1663 v1: 8.7 u1: mg/dl rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 95 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 87 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Phosphorous(2.7-4.5) Chemistry el: 0 cu: MICU cg: 1663 v1: 3.1 u1: mEq/L rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.5 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 129 rs: Final st: NotStopd
t0: [08:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 25/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [08:00:00 25/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [08:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 25/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [08:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 25/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [08:00:00 25/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 25/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [08:00:00 25/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 11 u1: points st: NotStopd t0: [08:00:00 25/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [08:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 25/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [08:00:00 25/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [08:00:00 25/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [08:00:00 25/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [08:00:00 25/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft Distended st: NotStopd t0: [08:00:00 25/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [08:00:00 25/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [08:00:00 25/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [08:00:00 25/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [08:00:00 25/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 25/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [08:00:00 25/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [08:00:00 25/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [08:00:00 25/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 25/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 25/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [08:00:00 25/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [08:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 128 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [08:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [08:00:00 25/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [08:00:00 25/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Other/Remarks st: NotStopd t0: [08:00:00 25/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: None/Remarks st: NotStopd t0: [08:00:00 25/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [08:00:00 25/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [08:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 25/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [08:00:00 25/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [08:00:00 25/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [08:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 48 u1: BPM st: NotStopd t0: [08:00:00 25/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 25/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [08:00:00 25/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [08:00:00 25/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [08:00:00 25/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [08:00:00 25/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [08:00:00 25/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [08:00:00 25/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [08:00:00 25/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [08:00:00 25/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [08:00:00 25/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [08:00:00 25/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [08:00:00 25/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [08:00:00 25/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 1.0 ET/Trach st: NotStopd t0: [08:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [08:00:00 25/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [08:00:00 25/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd t0: [08:00:00 25/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [08:00:00 25/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [08:00:00 25/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [08:00:00 25/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [08:00:00 25/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [08:00:00 25/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 16 u1: number st: NotStopd t0: [08:00:00 25/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd
t0: [08:00:00 25/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 120 vu: ml
t0: [06:00:00 25/02/2016] id: Magnesium Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd t0: [06:00:00 25/02/2016] id: Magnesium (1.6-2.6) Chemistry el: 0 cu: MICU cg: 1663 v1: 1.8 rs: Final st: NotStopd
t0: [10:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 25/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [10:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 77 u1: BPM st: NotStopd t0: [10:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 33 u1: BPM st: NotStopd t0: [10:00:00 25/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [10:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [10:00:00 25/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 240 vu: ml t0: [10:00:00 25/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vu: ml es: Large
t0: [23:00:00 25/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 25/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: MICU cg: RN cv: 0 ap: none t0: [23:00:00 25/02/2016] dt: 24 id: 24h Total In el: 2 cu: MICU cg: RN cv: 850 ap: none t0: [23:00:00 25/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: MICU cg: RN cv: 600 ap: none t0: [23:00:00 25/02/2016] dt: 24 id: Urine Out Total el: 2 cu: MICU cg: RN cv: 590 ap: carryForward t0: [23:00:00 25/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: MICU cg: RN cv: 260 ap: carryForward t0: [23:00:00 25/02/2016] dt: 24 id: 24h Total Out el: 2 cu: MICU cg: RN cv: 590 ap: carryForward t0: [23:00:00 25/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: MICU cg: RN cv: 7431.94 ap: carryForward
tf: [21:00:00 26/02/2016] pt: Unit Dose rt: PO fr: Q12H fs: 10, 22 dn: 2 m1: Pantoprazole v1: 40 u1: mg
t0: [09:00:00 25/02/2016] id: Eye Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 25/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 25/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [09:00:00 25/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Tan v2: Thick st: NotStopd t0: [09:00:00 25/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [09:00:00 25/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [11:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [11:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [11:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [11:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [11:00:00 25/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [11:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [11:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [11:00:00 25/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [11:00:00 25/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [11:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 158 u1: mmHg v2: 75 u2: mmHg st: NotStopd t0: [11:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 102.667 u1: mmHg st: NotStopd t0: [11:00:00 25/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: None/Remarks st: NotStopd t0: [11:00:00 25/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 25/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [11:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [11:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 42 u1: BPM st: NotStopd t0: [11:00:00 25/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [11:00:00 25/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [11:00:00 25/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Copious st: NotStopd t0: [11:00:00 25/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [11:00:00 25/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [11:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 25/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [11:00:00 25/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [11:00:00 25/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:00:00 25/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [11:00:00 25/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [11:00:00 25/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:00:00 25/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 25/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:00:00 25/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 45 st: NotStopd t0: [11:00:00 25/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:00:00 25/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:00:00 25/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [11:00:00 25/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [11:00:00 25/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [11:00:00 25/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [11:00:00 25/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 34 u1: BPM st: NotStopd t0: [11:00:00 25/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [11:00:00 25/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 326 u1: ml/B st: NotStopd t0: [11:00:00 25/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [11:00:00 25/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [11:00:00 25/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [11:00:00 25/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [11:00:00 25/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [11:00:00 25/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [12:33:00 25/02/2016] id: Venous CO2(Calc) VBG'S el: 0 cu: MICU cg: 1663 v1: 29 rs: Final st: NotStopd t0: [12:33:00 25/02/2016] id: Venous PvCO2 VBG's el: 0 cu: MICU cg: 1663 v1: 50 u1: mmHg rs: Final st: NotStopd t0: [12:33:00 25/02/2016] id: Venous PvO2 Mixed Venous Gases el: 0 cu: MICU cg: 1663 v1: 36 u1: mmHg rs: Final st: NotStopd t0: [12:33:00 25/02/2016] id: Venous pH VBG's el: 0 cu: MICU cg: 1663 v1: 7.35 u1: pH rs: Final st: NotStopd
t0: [12:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [12:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 136 u1: mmHg v2: 67 u2: mmHg st: NotStopd t0: [12:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 90 u1: mmHg st: NotStopd t0: [12:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 29 u1: BPM st: NotStopd t0: [12:00:00 25/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [12:00:00 25/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [12:00:00 25/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [12:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [14:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 25/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 25/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [14:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 25/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [14:00:00 25/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 25/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [14:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [14:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 25/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [14:00:00 25/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [14:00:00 25/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [14:00:00 25/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [14:00:00 25/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [14:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 144 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [14:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 95.3333 u1: mmHg st: NotStopd t0: [14:00:00 25/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: None/Remarks st: NotStopd t0: [14:00:00 25/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [14:00:00 25/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [14:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 25/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [14:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 36 u1: BPM st: NotStopd t0: [14:00:00 25/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [14:00:00 25/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [14:00:00 25/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [14:00:00 25/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [14:00:00 25/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [14:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [13:00:00 25/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vu: ml es: Large t0: [14:00:00 25/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 240 vu: ml t0: [14:00:00 25/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 100 vu: ml
t0: [09:00:00 25/02/2016] id: Stool Color/Consist el: 0 cu: MICU cg: RN v1: Brown v2: Formed st: NotStopd t0: [15:00:00 25/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RN v1: Blood Tinged v2: Thick st: NotStopd t0: [15:00:00 25/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RN v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 25/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [16:00:00 25/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [16:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 25/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [16:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 25/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [16:00:00 25/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [16:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [16:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 25/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [16:00:00 25/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [16:00:00 25/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 25/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [16:00:00 25/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [16:00:00 25/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [16:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 152 u1: mmHg v2: 71 u2: mmHg st: NotStopd t0: [16:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 98 u1: mmHg st: NotStopd t0: [16:00:00 25/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [16:00:00 25/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [16:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 25/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [16:00:00 25/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [16:00:00 25/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [16:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [16:00:00 25/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [16:00:00 25/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [16:00:00 25/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [16:00:00 25/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [16:00:00 25/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [16:00:00 25/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [16:00:00 25/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [16:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [16:00:00 25/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [16:00:00 25/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vu: ml es: Large
t0: [23:00:00 25/02/2016] dt: 24 id: Stool Out Total el: 2 cu: MICU cg: RN cv: 0 ap: carryForward
t0: [16:00:00 25/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [16:00:00 25/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [16:00:00 25/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [16:00:00 25/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bed as Chair st: NotStopd t0: [16:00:00 25/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [16:00:00 25/02/2016] id: Imp Skin Cleanse #1 el: 0 cu: MICU cg: RN v1: Soap & H20 st: NotStopd t0: [16:00:00 25/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [16:00:00 25/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 25/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [16:00:00 25/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [16:00:00 25/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [16:00:00 25/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: None/Remarks st: NotStopd t0: [16:00:00 25/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Left Side st: NotStopd t0: [16:00:00 25/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [16:00:00 25/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 25/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [16:00:00 25/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [16:00:00 25/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [16:00:00 25/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [16:00:00 25/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [16:00:00 25/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [16:00:00 25/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [16:00:00 25/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [16:00:00 25/02/2016] id: Braden Activity el: 0 cu: MICU cg: RN v1: Chairfast st: NotStopd t0: [16:00:00 25/02/2016] id: Braden Frict/Shear el: 0 cu: MICU cg: RN v1: Problem st: NotStopd t0: [16:00:00 25/02/2016] id: Braden Mobility el: 0 cu: MICU cg: RN v1: Sl. Limited st: NotStopd t0: [16:00:00 25/02/2016] id: Braden Moisture el: 0 cu: MICU cg: RN v1: Rarely Moist st: NotStopd t0: [16:00:00 25/02/2016] id: Braden Nutrition el: 0 cu: MICU cg: RN v1: Adequate st: NotStopd t0: [16:00:00 25/02/2016] id: Braden Score el: 0 cu: MICU cg: RN v1: 17 u1: number st: NotStopd t0: [16:00:00 25/02/2016] id: Braden SensoryPercep el: 0 cu: MICU cg: RN v1: No Impairment st: NotStopd
t0: [17:00:00 25/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [17:00:00 25/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [17:00:00 25/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [17:00:00 25/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [17:00:00 25/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 60 u1: BPM st: NotStopd t0: [17:00:00 25/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [17:00:00 25/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [17:00:00 25/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [17:00:00 25/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [17:00:00 25/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 45 st: NotStopd t0: [17:00:00 25/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [17:00:00 25/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [17:00:00 25/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [17:00:00 25/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.2 u1: L/min st: NotStopd t0: [17:00:00 25/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 5 u1: cmH2O st: NotStopd t0: [17:00:00 25/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [17:00:00 25/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 26 u1: BPM st: NotStopd t0: [17:00:00 25/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [17:00:00 25/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 343 u1: ml/B st: NotStopd t0: [17:00:00 25/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [17:00:00 25/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [17:00:00 25/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [17:00:00 25/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [17:00:00 25/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [17:00:00 25/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [07:00:00 25/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 60 u1: BPM st: NotStopd t0: [07:00:00 25/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 25/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 60 u1: BPM st: NotStopd t0: [11:00:00 25/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [17:00:00 25/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd
t0: [18:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [18:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [18:00:00 25/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [18:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [18:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [18:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 68 u1: BPM st: NotStopd t0: [18:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [18:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 142 u1: mmHg v2: 70 u2: mmHg st: NotStopd t0: [18:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 94 u1: mmHg st: NotStopd t0: [18:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [18:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 38 u1: BPM st: NotStopd t0: [18:00:00 25/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 98 u1: % st: NotStopd t0: [18:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [18:00:00 25/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 50 vu: ml
t0: [23:00:00 25/02/2016] dt: 24 id: IV Infusion In Total el: 2 cu: MICU cg: RN cv: 250 ap: none
t0: [19:00:00 25/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 120 vu: ml
t0: [20:40:00 25/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [20:40:00 25/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [20:40:00 25/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [20:40:00 25/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [20:40:00 25/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [20:40:00 25/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [20:40:00 25/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [20:40:00 25/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [20:40:00 25/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [20:40:00 25/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 45 st: NotStopd t0: [20:40:00 25/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 14 u1: cmH2O st: NotStopd t0: [20:40:00 25/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.9 u1: L/min st: NotStopd t0: [20:40:00 25/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [20:40:00 25/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [20:40:00 25/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [20:40:00 25/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [20:40:00 25/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [20:40:00 25/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 310 u1: ml/B st: NotStopd t0: [20:40:00 25/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [20:40:00 25/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [20:40:00 25/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [20:40:00 25/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [20:40:00 25/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [20:40:00 25/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 25/02/2016] id: Pain Present el: 0 cu: MICU cg: RN v1: No st: NotStopd t0: [20:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [20:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [20:00:00 25/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [20:00:00 25/02/2016] id: Daily Wake Up el: 1 cu: MICU cg: RN v1: No/Not Sedated st: NotStopd t0: [20:00:00 25/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [20:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [20:00:00 25/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [20:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 25/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [20:00:00 25/02/2016] id: Family Communication el: 0 cu: MICU cg: RN v1: Family Visited st: NotStopd t0: [20:00:00 25/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [20:00:00 25/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 30 degrees st: NotStopd t0: [20:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 67 u1: BPM st: NotStopd t0: [20:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [20:00:00 25/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [20:00:00 25/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [20:00:00 25/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [20:00:00 25/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [20:00:00 25/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [20:00:00 25/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [20:00:00 25/02/2016] id: ImpSkin Character #1 el: 0 cu: MICU cg: RN v1: Abrasion st: NotStopd t0: [20:00:00 25/02/2016] id: ImpSkin Drain/Amt#1 el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 25/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [20:00:00 25/02/2016] id: ImpSkin Wound Base#1 el: 0 cu: MICU cg: RN v1: Red st: NotStopd t0: [20:00:00 25/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [20:00:00 25/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [20:00:00 25/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 25/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [20:00:00 25/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [20:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 82 u2: mmHg st: NotStopd t0: [20:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104.667 u1: mmHg st: NotStopd t0: [20:00:00 25/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [20:00:00 25/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [20:00:00 25/02/2016] id: AntiEmbDevice/Status el: 0 cu: MICU cg: RN v1: None/Remarks st: NotStopd t0: [20:00:00 25/02/2016] id: Pain Location el: 0 cu: MICU cg: RN v1: Not Indicated st: NotStopd t0: [20:00:00 25/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Supine st: NotStopd t0: [20:00:00 25/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 2 Person Assist st: NotStopd t0: [20:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [20:00:00 25/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [20:00:00 25/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Clear st: NotStopd t0: [20:00:00 25/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [20:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 41 u1: BPM st: NotStopd t0: [20:00:00 25/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [20:00:00 25/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [20:00:00 25/02/2016] id: Skin Integrity el: 0 cu: MICU cg: RN v1: Impaired st: NotStopd t0: [20:00:00 25/02/2016] id: Skin Temp/Condition el: 0 cu: MICU cg: RN v1: Warm v2: Dry st: NotStopd t0: [20:00:00 25/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [20:00:00 25/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [20:00:00 25/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [20:00:00 25/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [20:00:00 25/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [20:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [20:00:00 25/02/2016] id: Behavior el: 0 cu: MICU cg: RN v1: Appropriate st: NotStopd t0: [20:00:00 25/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [20:00:00 25/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 140 vu: ml
t0: [20:00:00 25/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [20:00:00 25/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1667 u1: Deg. C st: NotStopd t0: [20:00:00 25/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.9 u1: Deg. F st: NotStopd t0: [22:00:00 25/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RN v1: 1 v2: 23 st: NotStopd t0: [22:00:00 25/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [22:00:00 25/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [22:00:00 25/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [22:00:00 25/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [22:00:00 25/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 25/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [22:00:00 25/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 62 u1: BPM st: NotStopd t0: [22:00:00 25/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [22:00:00 25/02/2016] id: Airway Size el: 0 cu: MICU cg: RN v1: 8.0 mm st: NotStopd t0: [22:00:00 25/02/2016] id: Airway Type el: 0 cu: MICU cg: RN v1: Tracheostomy st: NotStopd t0: [22:00:00 25/02/2016] id: Intubation Date el: 0 cu: MICU cg: RN v1: 12 v2: 23 st: NotStopd t0: [22:00:00 25/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 114 u1: mmHg v2: 58 u2: mmHg st: NotStopd t0: [22:00:00 25/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 76.6667 u1: mmHg st: NotStopd t0: [22:00:00 25/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [22:00:00 25/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [22:00:00 25/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RN v1: Yes v2: No st: NotStopd t0: [22:00:00 25/02/2016] id: Trach Size el: 0 cu: MICU cg: RN v1: #8 st: NotStopd t0: [22:00:00 25/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RN v1: Portex st: NotStopd t0: [22:00:00 25/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RN v1: Drager st: NotStopd t0: [22:00:00 25/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:35:00 26/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [00:35:00 26/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [00:35:00 26/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [00:35:00 26/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [00:35:00 26/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [00:35:00 26/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [00:35:00 26/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [00:35:00 26/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [00:35:00 26/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [00:35:00 26/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 45 st: NotStopd t0: [00:35:00 26/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [00:35:00 26/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [00:35:00 26/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 13 u1: cmH2O st: NotStopd t0: [00:35:00 26/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 12.2 u1: L/min st: NotStopd t0: [00:35:00 26/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [00:35:00 26/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [00:35:00 26/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [00:35:00 26/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [00:35:00 26/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [00:35:00 26/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 250 u1: ml/B st: NotStopd t0: [00:35:00 26/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [00:35:00 26/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [00:35:00 26/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [00:35:00 26/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [00:35:00 26/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [00:35:00 26/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [00:00:00 26/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Bloody v2: Thick st: NotStopd t0: [00:00:00 26/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd
t0: [00:00:00 26/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [00:00:00 26/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [00:00:00 26/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [00:00:00 26/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 26/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [00:00:00 26/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 26/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 26/02/2016] id: Alarms el: 0 cu: MICU cg: RN v1: ON st: NotStopd t0: [00:00:00 26/02/2016] id: Parameters Checked el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [00:00:00 26/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [00:00:00 26/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [00:00:00 26/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 26/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 59 u1: BPM st: NotStopd t0: [00:00:00 26/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [00:00:00 26/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 15 degrees st: NotStopd t0: [00:00:00 26/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [00:00:00 26/02/2016] id: Activity Tolerance el: 0 cu: MICU cg: RN v1: Tolerated Well st: NotStopd t0: [00:00:00 26/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [00:00:00 26/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 26/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 26/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [00:00:00 26/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [00:00:00 26/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 134 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [00:00:00 26/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 88.6667 u1: mmHg st: NotStopd t0: [00:00:00 26/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [00:00:00 26/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [00:00:00 26/02/2016] id: Position el: 0 cu: MICU cg: RN v1: Right Side st: NotStopd t0: [00:00:00 26/02/2016] id: Assistance Device el: 0 cu: MICU cg: RN v1: 1 Person Assist st: NotStopd t0: [00:00:00 26/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [00:00:00 26/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [00:00:00 26/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [00:00:00 26/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [00:00:00 26/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [00:00:00 26/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [00:00:00 26/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [00:00:00 26/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [00:00:00 26/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [00:00:00 26/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 36.6667 u1: Deg. C st: NotStopd t0: [00:00:00 26/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98 u1: Deg. F st: NotStopd t0: [00:00:00 26/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [00:00:00 26/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Side to Side st: NotStopd t0: [00:00:00 26/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [00:00:00 26/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [00:00:00 26/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [00:00:00 26/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [00:00:00 26/02/2016] id: Po Intake PO/Gastric el: 1 cu: MICU cg: RN ai: 103 vo: 100 vu: ml t0: [00:00:00 26/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 160 vu: ml
t0: [23:00:00 26/02/2016] dt: 1 id: Total Hourly Output el: 2 cu: -1 cg: RN cv: 0 ap: none t0: [23:00:00 26/02/2016] dt: 1 id: Net Hourly Balance el: 2 cu: -1 cg: RN cv: 0 ap: none t0: [23:00:00 26/02/2016] dt: 24 id: 24h Total In el: 2 cu: -1 cg: RN cv: 100 ap: none t0: [23:00:00 26/02/2016] dt: 24 id: PO/Gastric In Total el: 2 cu: -1 cg: RN cv: 100 ap: none t0: [23:00:00 26/02/2016] dt: 24 id: Urine Out Total el: 2 cu: -1 cg: RN cv: 1080 ap: none t0: [23:00:00 26/02/2016] dt: 24 id: 24h Net Body Balance el: 2 cu: -1 cg: RN cv: -980 ap: none t0: [23:00:00 26/02/2016] dt: 24 id: 24h Total Out el: 2 cu: -1 cg: RN cv: 1080 ap: none t0: [23:00:00 26/02/2016] dt: multiple days id: LOS Net Body Balance el: 2 cu: -1 cg: RN cv: 6451.94 ap: carryForward
t0: [02:00:00 26/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [02:00:00 26/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [02:00:00 26/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [02:00:00 26/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 26/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [02:00:00 26/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 57 u1: BPM st: NotStopd t0: [02:00:00 26/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [02:00:00 26/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [02:00:00 26/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 50 u1: BPM st: NotStopd t0: [02:00:00 26/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [02:00:00 26/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 115 u1: mmHg v2: 54 u2: mmHg st: NotStopd t0: [02:00:00 26/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 74.3333 u1: mmHg st: NotStopd
t0: [04:40:00 26/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [04:40:00 26/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [04:40:00 26/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [04:40:00 26/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [04:40:00 26/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 50 u1: BPM st: NotStopd t0: [04:40:00 26/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [04:40:00 26/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [04:40:00 26/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35.1 u1: Deg. C st: NotStopd t0: [04:40:00 26/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [04:40:00 26/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 45 st: NotStopd t0: [04:40:00 26/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [04:40:00 26/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.6 u1: L/min st: NotStopd t0: [04:40:00 26/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [04:40:00 26/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [04:40:00 26/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [04:40:00 26/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 33 u1: BPM st: NotStopd t0: [04:40:00 26/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [04:40:00 26/02/2016] id: Spon RR (Mech.) el: 0 cu: MICU cg: RRT v1: 44 u1: BPM st: NotStopd t0: [04:40:00 26/02/2016] id: Spon. Vt (L) (Mech.) el: 0 cu: MICU cg: RRT v1: 0.2 u1: L st: NotStopd t0: [04:40:00 26/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 270 u1: ml/B st: NotStopd t0: [04:40:00 26/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [04:40:00 26/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [04:40:00 26/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [04:40:00 26/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [04:40:00 26/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [04:40:00 26/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [20:00:00 25/02/2016] id: Oral Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 25/02/2016] id: Skin Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [20:00:00 25/02/2016] id: Back Care el: 0 cu: MICU cg: RN v1: Done st: NotStopd t0: [00:00:00 26/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [00:00:00 26/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [00:00:00 26/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [00:00:00 26/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 99 u1: % st: NotStopd t0: [02:00:00 26/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [02:00:00 26/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 26/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [04:00:00 26/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [04:00:00 26/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [04:00:00 26/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [04:00:00 26/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [04:00:00 26/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 26/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 26/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [04:00:00 26/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Sinus Brady st: NotStopd t0: [04:00:00 26/02/2016] id: INV Line#1 Type/Site el: 0 cu: MICU cg: RN v1: PICC line v2: Left Antecub st: NotStopd t0: [04:00:00 26/02/2016] id: INV Line#1InsertDate el: 0 cu: MICU cg: RN v1: 1 v2: 30 st: NotStopd t0: [04:00:00 26/02/2016] id: INV Line#1SiteAppear el: 0 cu: MICU cg: RN v1: WNL st: NotStopd t0: [04:00:00 26/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [04:00:00 26/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Sleeping st: NotStopd t0: [04:00:00 26/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 130 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [04:00:00 26/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 87.3333 u1: mmHg st: NotStopd t0: [04:00:00 26/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [04:00:00 26/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [04:00:00 26/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [04:00:00 26/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 58 u1: BPM st: NotStopd t0: [04:00:00 26/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [04:00:00 26/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [04:00:00 26/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [04:00:00 26/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [04:00:00 26/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [04:00:00 26/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [04:00:00 26/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 26/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [06:00:00 26/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [06:00:00 26/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [06:00:00 26/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [06:00:00 26/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 26/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [06:00:00 26/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 64 u1: BPM st: NotStopd t0: [06:00:00 26/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [06:00:00 26/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 146 u1: mmHg v2: 66 u2: mmHg st: NotStopd t0: [06:00:00 26/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 92.6667 u1: mmHg st: NotStopd t0: [06:00:00 26/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [06:00:00 26/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 31 u1: BPM st: NotStopd t0: [06:00:00 26/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [06:00:00 26/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [06:00:00 26/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 180 vu: ml
t0: [07:00:00 26/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [07:00:00 26/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [07:00:00 26/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [07:00:00 26/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [07:00:00 26/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [07:00:00 26/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [07:00:00 26/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [07:00:00 26/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [07:00:00 26/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [07:00:00 26/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 45 st: NotStopd t0: [07:00:00 26/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [07:00:00 26/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [07:00:00 26/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [07:00:00 26/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 9.8 u1: L/min st: NotStopd t0: [07:00:00 26/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [07:00:00 26/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [07:00:00 26/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 20 u1: . st: NotStopd t0: [07:00:00 26/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 36 u1: BPM st: NotStopd t0: [07:00:00 26/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [07:00:00 26/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Yellow v2: Thick st: NotStopd t0: [07:00:00 26/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Small st: NotStopd t0: [07:00:00 26/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 298 u1: ml/B st: NotStopd t0: [07:00:00 26/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [07:00:00 26/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [07:00:00 26/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [07:00:00 26/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [07:00:00 26/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [07:00:00 26/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [06:00:00 26/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 12.6 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: WBC Hematology el: 0 cu: MICU cg: 1663 v1: 12.6 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Hematocrit Hematology el: 0 cu: MICU cg: 1663 v1: 28.9 u1: % rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Hemoglobin Hematology el: 0 cu: MICU cg: 1663 v1: 9.1 u1: gm/dl rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Platelets Hematology el: 0 cu: MICU cg: 1663 v1: 360 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: RBC Hematology el: 0 cu: MICU cg: 1663 v1: 3.2 u1: /mic l rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: WBC (4-11,000) Hematology el: 0 cu: MICU cg: 1663 v1: 12.6 rs: Final st: NotStopd
t0: [06:00:00 26/02/2016] id: BUN el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Chloride Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Creatinine Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Glucose Chemistry el: 0 cu: MICU cg: 1663 v1: 78 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Potassium Chemistry el: 0 cu: MICU cg: 1663 v1: 4.5 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Sodium Chemistry el: 0 cu: MICU cg: 1663 v1: 130 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: BUN (6-20) Chemistry el: 0 cu: MICU cg: 1663 v1: 20 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Carbon Dioxide Chemistry el: 0 cu: MICU cg: 1663 v1: 28 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Chloride (100-112) Chemistry el: 0 cu: MICU cg: 1663 v1: 96 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Creatinine (0-1.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 0.9 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Glucose (70-105) Chemistry el: 0 cu: MICU cg: 1663 v1: 78 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Potassium (3.5-5.3) Chemistry el: 0 cu: MICU cg: 1663 v1: 4.5 rs: Final st: NotStopd t0: [06:00:00 26/02/2016] id: Sodium (135-148) Chemistry el: 0 cu: MICU cg: 1663 v1: 130 rs: Final st: NotStopd
t0: [08:00:00 26/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [08:00:00 26/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [08:00:00 26/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [08:00:00 26/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 26/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [08:00:00 26/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [08:00:00 26/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [08:00:00 26/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 141 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [08:00:00 26/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 93 u1: mmHg st: NotStopd t0: [08:00:00 26/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [08:00:00 26/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 61 u1: BPM st: NotStopd t0: [08:00:00 26/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd t0: [09:00:00 26/02/2016] id: GI Prophylaxis el: 0 cu: MICU cg: RN v1: Proton/Pump/Inhi st: NotStopd t0: [09:00:00 26/02/2016] id: Diet Type el: 0 cu: MICU cg: RN v1: Soft Solid st: NotStopd t0: [09:00:00 26/02/2016] id: Dorsal PedPulse R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [09:00:00 26/02/2016] id: Eye Opening el: 0 cu: MICU cg: RN v1: 4 Spontaneously st: NotStopd t0: [09:00:00 26/02/2016] id: GCS Total el: 0 cu: MICU cg: RN v1: 15 u1: points st: NotStopd t0: [09:00:00 26/02/2016] id: HOB el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [09:00:00 26/02/2016] id: Height of Bed el: 0 cu: MICU cg: RN v1: 45 degrees st: NotStopd t0: [09:00:00 26/02/2016] id: Abdominal Assessment el: 0 cu: MICU cg: RN v1: Soft st: NotStopd t0: [09:00:00 26/02/2016] id: Activity el: 0 cu: MICU cg: RN v1: Bedrest st: NotStopd t0: [09:00:00 26/02/2016] id: ImpSkin Treatment #1 el: 0 cu: MICU cg: RN v1: Duoderm st: NotStopd t0: [09:00:00 26/02/2016] id: Impaired Skin Site#1 el: 0 cu: MICU cg: RN v1: Coccyx st: NotStopd t0: [09:00:00 26/02/2016] id: LLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [09:00:00 26/02/2016] id: LUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 26/02/2016] id: Level of Conscious el: 0 cu: MICU cg: RN v1: Alert st: NotStopd t0: [09:00:00 26/02/2016] id: Motor Response el: 0 cu: MICU cg: RN v1: 6 Obeys Commands st: NotStopd t0: [09:00:00 26/02/2016] id: Oral Cavity el: 0 cu: MICU cg: RN v1: Teeth/Tissue WNL st: NotStopd t0: [09:00:00 26/02/2016] id: Orientation el: 0 cu: MICU cg: RN v1: Oriented x 3 st: NotStopd t0: [09:00:00 26/02/2016] id: PostTib. Pulses R/L el: 0 cu: MICU cg: RN v1: Easily Palpable v2: Easily Palpable st: NotStopd t0: [09:00:00 26/02/2016] id: RLL Lung Sounds el: 0 cu: MICU cg: RN v1: Diminished st: NotStopd t0: [09:00:00 26/02/2016] id: RUL Lung Sounds el: 0 cu: MICU cg: RN v1: Coarse st: NotStopd t0: [09:00:00 26/02/2016] id: Respiratory Pattern el: 0 cu: MICU cg: RN v1: Regular st: NotStopd t0: [09:00:00 26/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [09:00:00 26/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [09:00:00 26/02/2016] id: Support Systems el: 0 cu: MICU cg: RN v1: Spouse st: NotStopd t0: [09:00:00 26/02/2016] id: Therapeutic Bed el: 0 cu: MICU cg: RN v1: AirMatt/1st Step st: NotStopd t0: [09:00:00 26/02/2016] id: Turn el: 0 cu: MICU cg: RN v1: Back st: NotStopd t0: [09:00:00 26/02/2016] id: Urine Color/Appear el: 0 cu: MICU cg: RN v1: Yellow v2: Clear st: NotStopd t0: [09:00:00 26/02/2016] id: Urine Source el: 0 cu: MICU cg: RN v1: Condom Catheter st: NotStopd t0: [09:00:00 26/02/2016] id: Verbal Response el: 0 cu: MICU cg: RN v1: 5 Oriented st: NotStopd t0: [09:00:00 26/02/2016] id: Bowel Sounds el: 0 cu: MICU cg: RN v1: Present st: NotStopd
t0: [09:00:00 26/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 280 vu: ml
t0: [10:00:00 26/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [10:00:00 26/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [10:00:00 26/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [10:00:00 26/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [10:00:00 26/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 70 u1: BPM st: NotStopd t0: [10:00:00 26/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [10:00:00 26/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 137 u1: mmHg v2: 88 u2: mmHg st: NotStopd t0: [10:00:00 26/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104.333 u1: mmHg st: NotStopd t0: [10:00:00 26/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [10:00:00 26/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 37 u1: BPM st: NotStopd t0: [10:00:00 26/02/2016] id: Temp. Site el: 0 cu: MICU cg: RN v1: Oral st: NotStopd t0: [10:00:00 26/02/2016] id: Temperature C (calc) el: 0 cu: MICU cg: RN v1: 37.1111 u1: Deg. C st: NotStopd t0: [10:00:00 26/02/2016] id: Temperature F el: 0 cu: MICU cg: RN v1: 98.8 u1: Deg. F st: NotStopd t0: [10:00:00 26/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [11:00:00 26/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [11:00:00 26/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [11:00:00 26/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [11:00:00 26/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [11:00:00 26/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [11:00:00 26/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [11:00:00 26/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [11:00:00 26/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [11:00:00 26/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [11:00:00 26/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 45 st: NotStopd t0: [11:00:00 26/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [11:00:00 26/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [11:00:00 26/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [11:00:00 26/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 10.4 u1: L/min st: NotStopd t0: [11:00:00 26/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [11:00:00 26/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [11:00:00 26/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 18 u1: . st: NotStopd t0: [11:00:00 26/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 38 u1: BPM st: NotStopd t0: [11:00:00 26/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [11:00:00 26/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [11:00:00 26/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [11:00:00 26/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 279 u1: ml/B st: NotStopd t0: [11:00:00 26/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [11:00:00 26/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [11:00:00 26/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [11:00:00 26/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [11:00:00 26/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [11:00:00 26/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd
t0: [10:00:00 26/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 26/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [12:00:00 26/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [12:00:00 26/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [12:00:00 26/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [12:00:00 26/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 63 u1: BPM st: NotStopd t0: [12:00:00 26/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [12:00:00 26/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 150 u1: mmHg v2: 69 u2: mmHg st: NotStopd t0: [12:00:00 26/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 96 u1: mmHg st: NotStopd t0: [12:00:00 26/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [12:00:00 26/02/2016] id: Radiologic Study el: 0 cu: MICU cg: RN v1: CT scan st: NotStopd t0: [12:00:00 26/02/2016] id: SpO2 el: 0 cu: MICU cg: RN v1: 100 u1: % st: NotStopd t0: [12:00:00 26/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [12:00:00 26/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 300 vu: ml
t0: [14:00:00 26/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [14:00:00 26/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [14:00:00 26/02/2016] id: Riker-SAS Scale el: 0 cu: MICU cg: RN v1: Calm/Cooperative st: NotStopd t0: [14:00:00 26/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [14:00:00 26/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 26/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 26/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 66 u1: BPM st: NotStopd t0: [14:00:00 26/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [14:00:00 26/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 156 u1: mmHg v2: 72 u2: mmHg st: NotStopd t0: [14:00:00 26/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 100 u1: mmHg st: NotStopd t0: [14:00:00 26/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [14:00:00 26/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 35 u1: BPM st: NotStopd t0: [14:00:00 26/02/2016] id: Restraint Location el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [14:00:00 26/02/2016] id: Side Rails el: 0 cu: MICU cg: RN v1: Side Rails Up st: NotStopd t0: [14:00:00 26/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [14:00:00 26/02/2016] id: Urine Out Condom Cath el: 1 cu: MICU cg: RN vo: 160 vu: ml
t0: [16:00:00 26/02/2016] id: Service Type el: 0 cu: MICU cg: RN v1: MICU st: NotStopd t0: [16:00:00 26/02/2016] id: Code Status el: 0 cu: MICU cg: RN v1: Full Code st: NotStopd t0: [16:00:00 26/02/2016] id: Risk for Falls el: 0 cu: MICU cg: RN v1: Yes st: NotStopd t0: [16:00:00 26/02/2016] id: Ectopy Frequency el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 26/02/2016] id: Ectopy Type el: 0 cu: MICU cg: RN v1: None st: NotStopd t0: [16:00:00 26/02/2016] id: Heart Rate el: 0 cu: MICU cg: RN v1: 69 u1: BPM st: NotStopd t0: [16:00:00 26/02/2016] id: Heart Rhythm el: 0 cu: MICU cg: RN v1: Normal Sinus st: NotStopd t0: [16:00:00 26/02/2016] id: NBP el: 0 cu: MICU cg: RN v1: 160 u1: mmHg v2: 76 u2: mmHg st: NotStopd t0: [16:00:00 26/02/2016] id: NBP Mean el: 0 cu: MICU cg: RN v1: 104 u1: mmHg st: NotStopd t0: [16:00:00 26/02/2016] id: Precautions el: 0 cu: MICU cg: RN v1: Universal st: NotStopd t0: [16:00:00 26/02/2016] id: Respiratory Rate el: 0 cu: MICU cg: RN v1: 21 u1: BPM st: NotStopd t0: [16:00:00 26/02/2016] id: calprevflg el: 0 cu: MICU cg: RN v1: 1 u1: kg st: NotStopd
t0: [16:00:00 26/02/2016] id: Trach Insert Date el: 0 cu: MICU cg: RRT v1: 1 v2: 23 st: NotStopd t0: [16:00:00 26/02/2016] id: Cuff Leak el: 0 cu: MICU cg: RRT v1: No st: NotStopd t0: [16:00:00 26/02/2016] id: FiO2 Set el: 0 cu: MICU cg: RRT v1: 0.3 u1: torr st: NotStopd t0: [16:00:00 26/02/2016] id: High Insp. Pressure el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [16:00:00 26/02/2016] id: High Resp. Rate el: 0 cu: MICU cg: RRT v1: 55 u1: BPM st: NotStopd t0: [16:00:00 26/02/2016] id: Airway Size el: 0 cu: MICU cg: RRT v1: 8.0 mm st: NotStopd t0: [16:00:00 26/02/2016] id: Airway Type el: 0 cu: MICU cg: RRT v1: Tracheostomy st: NotStopd t0: [16:00:00 26/02/2016] id: Inspired Gas Temp el: 0 cu: MICU cg: RRT v1: 35 u1: Deg. C st: NotStopd t0: [16:00:00 26/02/2016] id: Intubation Date el: 0 cu: MICU cg: RRT v1: 12 v2: 23 st: NotStopd t0: [16:00:00 26/02/2016] id: Low Exhaled Min Vol el: 0 cu: MICU cg: RRT v1: 45 st: NotStopd t0: [16:00:00 26/02/2016] id: MDI #1 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Albuterol st: NotStopd t0: [16:00:00 26/02/2016] id: MDI #2 (Puff/Drug) el: 0 cu: MICU cg: RRT v1: 6 v2: Atrovent st: NotStopd t0: [16:00:00 26/02/2016] id: Mean Airway Pressure el: 0 cu: MICU cg: RRT v1: 12 u1: cmH2O st: NotStopd t0: [16:00:00 26/02/2016] id: Minute Volume(Obser) el: 0 cu: MICU cg: RRT v1: 11 u1: L/min st: NotStopd t0: [16:00:00 26/02/2016] id: PEEP Set el: 0 cu: MICU cg: RRT v1: 8 u1: cmH2O st: NotStopd t0: [16:00:00 26/02/2016] id: Apnea Time Interval el: 0 cu: MICU cg: RRT v1: 20 st: NotStopd t0: [16:00:00 26/02/2016] id: Pressure Support el: 0 cu: MICU cg: RRT v1: 18 u1: . st: NotStopd t0: [16:00:00 26/02/2016] id: Resp Rate (Total) el: 0 cu: MICU cg: RRT v1: 39 u1: BPM st: NotStopd t0: [16:00:00 26/02/2016] id: Sensitivity-Vent el: 0 cu: MICU cg: RRT v1: 4 u1: cmH2O st: NotStopd t0: [16:00:00 26/02/2016] id: Sputum Color/Consist el: 0 cu: MICU cg: RRT v1: Blood Tinged v2: Thick st: NotStopd t0: [16:00:00 26/02/2016] id: Sputum Source/Amt el: 0 cu: MICU cg: RRT v1: Suctioned v2: Moderate st: NotStopd t0: [16:00:00 26/02/2016] id: Tidal Volume (Obser) el: 0 cu: MICU cg: RRT v1: 262 u1: ml/B st: NotStopd t0: [16:00:00 26/02/2016] id: Trach Cuff/Fenestra el: 0 cu: MICU cg: RRT v1: Yes v2: No st: NotStopd t0: [16:00:00 26/02/2016] id: Trach Size el: 0 cu: MICU cg: RRT v1: #8 st: NotStopd t0: [16:00:00 26/02/2016] id: Tracheostomy Cuff el: 0 cu: MICU cg: RRT v1: Inflated st: NotStopd t0: [16:00:00 26/02/2016] id: Tracheostomy Type el: 0 cu: MICU cg: RRT v1: Portex st: NotStopd t0: [16:00:00 26/02/2016] id: Ventilator Mode el: 0 cu: MICU cg: RRT v1: CPAP+PS st: NotStopd t0: [16:00:00 26/02/2016] id: Ventilator Type el: 0 cu: MICU cg: RRT v1: Drager st: NotStopd